Provider Demographics
NPI:1609256254
Name:QUINTON, KELSEY MERLE (DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MERLE
Last Name:QUINTON
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 1:1807 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2305
Mailing Address - Country:US
Mailing Address - Phone:757-291-3837
Mailing Address - Fax:
Practice Address - Street 1:5300 HICKORY PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2629
Practice Address - Country:US
Practice Address - Phone:804-270-7754
Practice Address - Fax:804-270-7756
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist