Provider Demographics
NPI:1609120633
Name:DEERY, KELSEY N (DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:N
Last Name:DEERY
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 1:2420 E BURR OAK CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6101
Mailing Address - Country:US
Mailing Address - Phone:194-137-4032
Mailing Address - Fax:
Practice Address - Street 1:2420 E BURR OAK CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6101
Practice Address - Country:US
Practice Address - Phone:941-374-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist