Provider Demographics
NPI:1619411683
Name:KELLAR, KELSEY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:KELLAR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10459 MOUNTAIN VIEW AVE STE G
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2033
Mailing Address - Country:US
Mailing Address - Phone:909-478-9508
Mailing Address - Fax:909-478-9518
Practice Address - Street 1:1329 BARTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4419
Practice Address - Country:US
Practice Address - Phone:360-909-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-11
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2914812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic