Provider Demographics
NPI:1992115687
Name:HALL, KELSEY D (LMT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 W SAND LAKE RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5416
Mailing Address - Country:US
Mailing Address - Phone:407-257-7659
Mailing Address - Fax:
Practice Address - Street 1:7800 W SAND LAKE RD
Practice Address - Street 2:SUITE 213
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5416
Practice Address - Country:US
Practice Address - Phone:407-257-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA20791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist