Provider Demographics
NPI:1770232266
Name:MONTGOMERY, KELSEY LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LYNN
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:13847 W 63RD ST STE 2
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-3800
Practice Address - Country:US
Practice Address - Phone:913-962-7774
Practice Address - Fax:913-962-7775
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist