Provider Demographics
NPI:1225404064
Name:SWEENEY, KELSEY (DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:STONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:177 CHAMPION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3711
Mailing Address - Country:US
Mailing Address - Phone:814-238-3485
Mailing Address - Fax:814-692-2272
Practice Address - Street 1:177 CHAMPION DR STE 100
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3711
Practice Address - Country:US
Practice Address - Phone:814-238-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT026516OtherSTATE LICENSE