Provider Demographics
NPI:1174045694
Name:GRODE, KELSEY (PT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:GRODE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1521 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2620
Mailing Address - Country:US
Mailing Address - Phone:814-864-0671
Mailing Address - Fax:
Practice Address - Street 1:1521 W 54TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2620
Practice Address - Country:US
Practice Address - Phone:814-864-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist