Provider Demographics
NPI:1518720846
Name:BOLEN, KELSEY DANIELLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:DANIELLE
Last Name:BOLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 FRANK VANHOOSE BR
Mailing Address - Street 2:
Mailing Address - City:STAMBAUGH
Mailing Address - State:KY
Mailing Address - Zip Code:41257-9302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1391
Practice Address - Country:US
Practice Address - Phone:606-422-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist