Provider Demographics
NPI:1497300321
Name:HULSTROM, KELSEA JANELLE WEBER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEA
Middle Name:JANELLE WEBER
Last Name:HULSTROM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEA
Other - Middle Name:J
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:170 SW SCALEHOUSE LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1255
Mailing Address - Country:US
Mailing Address - Phone:541-316-0805
Mailing Address - Fax:
Practice Address - Street 1:170 SW SCALEHOUSE LOOP STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1255
Practice Address - Country:US
Practice Address - Phone:541-316-0805
Practice Address - Fax:541-241-7670
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist