Provider Demographics
NPI:1639424815
Name:SWAN, KELSEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 34669
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0669
Mailing Address - Country:US
Mailing Address - Phone:402-932-6791
Mailing Address - Fax:402-933-3163
Practice Address - Street 1:8419 S 73RD PLZ
Practice Address - Street 2:SUITE 104
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-1507
Practice Address - Country:US
Practice Address - Phone:402-991-2745
Practice Address - Fax:402-991-2748
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist