Provider Demographics
NPI:1194206813
Name:KELSO, ROBERT CLAYTON
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CLAYTON
Last Name:KELSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 DEER XING
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-5817
Mailing Address - Country:US
Mailing Address - Phone:940-781-9356
Mailing Address - Fax:
Practice Address - Street 1:415 INDIAN OAKS DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-6202
Practice Address - Country:US
Practice Address - Phone:254-699-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist