Provider Demographics
NPI:1407460116
Name:GREGORY, KELSEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:SPITALNIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 E 4TH ST APT 146
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4524
Mailing Address - Country:US
Mailing Address - Phone:401-595-4156
Mailing Address - Fax:
Practice Address - Street 1:6303 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3546
Practice Address - Country:US
Practice Address - Phone:520-325-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist