Provider Demographics
NPI:1447775465
Name:MAKI, KELSEY ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:MAKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:STUHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3700 CROSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4137
Mailing Address - Country:US
Mailing Address - Phone:979-774-9958
Mailing Address - Fax:979-774-9978
Practice Address - Street 1:3700 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4137
Practice Address - Country:US
Practice Address - Phone:979-774-9958
Practice Address - Fax:979-774-9978
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1296635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist