Provider Demographics
NPI:1992940928
Name:JAMES H. KELSON, A PROFESSIONAL PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:JAMES H. KELSON, A PROFESSIONAL PHYSICAL THERAPY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOZLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-492-6577
Mailing Address - Street 1:636 E STATE RD
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2151
Mailing Address - Country:US
Mailing Address - Phone:801-492-6577
Mailing Address - Fax:801-492-6579
Practice Address - Street 1:636 E STATE RD
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2151
Practice Address - Country:US
Practice Address - Phone:801-492-6577
Practice Address - Fax:801-492-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1122412401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty