Provider Demographics
NPI:1114418530
Name:YORK, KELSEY TAYLOR (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:TAYLOR
Last Name:YORK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LAMONT CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-4557
Mailing Address - Country:US
Mailing Address - Phone:434-444-0005
Mailing Address - Fax:
Practice Address - Street 1:203 LAMONT CIR
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-4557
Practice Address - Country:US
Practice Address - Phone:434-444-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602087225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10171984Medicaid