Provider Demographics
NPI:1295226314
Name:TRIPP, KELSEY (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TRIPP
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W COUNCIL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4135
Mailing Address - Country:US
Mailing Address - Phone:561-222-4926
Mailing Address - Fax:
Practice Address - Street 1:621 W COUNCIL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4135
Practice Address - Country:US
Practice Address - Phone:561-222-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0032492255A2300X
NCLAT-40452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer