Provider Demographics
NPI:1760192645
Name:SOLDNER, KELSEY BLAIRE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BLAIRE
Last Name:SOLDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5958 BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9541
Mailing Address - Country:US
Mailing Address - Phone:419-450-9382
Mailing Address - Fax:
Practice Address - Street 1:2100 PARK RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4938
Practice Address - Country:US
Practice Address - Phone:419-450-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist