Provider Demographics
NPI:1699822783
Name:KELSEY, SANDRA LUCILLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LUCILLE
Last Name:KELSEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LUCILLE
Other - Last Name:MCKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:871 TURNPIKE ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6127
Mailing Address - Country:US
Mailing Address - Phone:978-746-5295
Mailing Address - Fax:
Practice Address - Street 1:871 TURNPIKE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6127
Practice Address - Country:US
Practice Address - Phone:978-746-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT 01187225100000X
MA11648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist