Provider Demographics
NPI:1588908941
Name:KELSEY, CHANDIMA (DPT)
Entity type:Individual
Prefix:
First Name:CHANDIMA
Middle Name:
Last Name:KELSEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHANDIMA
Other - Middle Name:
Other - Last Name:JAYAWARDENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1015 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4821
Mailing Address - Country:US
Mailing Address - Phone:515-432-7729
Mailing Address - Fax:
Practice Address - Street 1:1015 UNION ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4821
Practice Address - Country:US
Practice Address - Phone:515-432-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist