Provider Demographics
NPI:1437625530
Name:REICH, KELSEY SARA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:SARA
Last Name:REICH
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TAMMY LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-8878
Mailing Address - Country:US
Mailing Address - Phone:484-706-0533
Mailing Address - Fax:
Practice Address - Street 1:400 SHARP AVE
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19560
Practice Address - Country:US
Practice Address - Phone:484-955-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0070832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer