Provider Demographics
NPI:1639897572
Name:GINGRAS, KELSEY DAWN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:DAWN
Last Name:GINGRAS
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 1:269 PARTRIDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-6707
Mailing Address - Country:US
Mailing Address - Phone:508-887-1851
Mailing Address - Fax:
Practice Address - Street 1:239 MILL ST STE B
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3191
Practice Address - Country:US
Practice Address - Phone:508-752-8466
Practice Address - Fax:774-243-6611
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist