Provider Demographics
NPI:1003835117
Name:KELSEY, HENREY DWIGHT (PT)
Entity Type:Individual
Prefix:
First Name:HENREY
Middle Name:DWIGHT
Last Name:KELSEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LOMITA BLVD
Mailing Address - Street 2:STE M100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-325-7404
Mailing Address - Fax:310-325-4971
Practice Address - Street 1:3500 LOMITA BLVD
Practice Address - Street 2:STE M100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-325-7404
Practice Address - Fax:310-325-4971
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT5790AMedicare ID - Type Unspecified
R37157Medicare UPIN