Provider Demographics
NPI:1073061180
Name:DENNIS, KELSEY (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 S MOUNT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-8513
Mailing Address - Country:US
Mailing Address - Phone:989-763-5615
Mailing Address - Fax:
Practice Address - Street 1:6460 S MOUNT HOPE RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-8513
Practice Address - Country:US
Practice Address - Phone:989-763-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302428225100000X
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist