Provider Demographics
NPI:1992167290
Name:KELSEY, ANTHONY (PTA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:KELSEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 LEPPERT RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9721
Mailing Address - Country:US
Mailing Address - Phone:419-438-0873
Mailing Address - Fax:
Practice Address - Street 1:120 COLEMANS XING
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7115
Practice Address - Country:US
Practice Address - Phone:937-578-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant