Provider Demographics
NPI:1083049522
Name:WILSON, KELSI RANAE (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KELSI
Middle Name:RANAE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-1228
Mailing Address - Country:US
Mailing Address - Phone:406-932-2451
Mailing Address - Fax:
Practice Address - Street 1:701 STOCK ST
Practice Address - Street 2:
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011-8071
Practice Address - Country:US
Practice Address - Phone:406-932-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-1764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist