Provider Demographics
NPI:1740419969
Name:HEARN, KELSEY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:LYNN
Last Name:HEARN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 GENERAL BOOTH BLVD
Mailing Address - Street 2:SUITE 152
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5881
Mailing Address - Country:US
Mailing Address - Phone:757-430-8828
Mailing Address - Fax:757-430-8189
Practice Address - Street 1:2135 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE 152
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5881
Practice Address - Country:US
Practice Address - Phone:757-430-8828
Practice Address - Fax:757-430-8189
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist