Provider Demographics
NPI:1760031181
Name:HAJOVSKY, KELSEY JO (PTA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JO
Last Name:HAJOVSKY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 S FM 441 RD
Mailing Address - Street 2:
Mailing Address - City:LOUISE
Mailing Address - State:TX
Mailing Address - Zip Code:77455-4452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:248 WISTERIA LN
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-2545
Practice Address - Country:US
Practice Address - Phone:979-648-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2083687225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant