Provider Demographics
NPI:1790274926
Name:SORGE, KELSEY SHEA
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:SHEA
Last Name:SORGE
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 1:3050 GUERNSEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1540
Mailing Address - Country:US
Mailing Address - Phone:740-325-1120
Mailing Address - Fax:740-325-1743
Practice Address - Street 1:3050 GUERNSEY ST STE B
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1540
Practice Address - Country:US
Practice Address - Phone:740-325-1120
Practice Address - Fax:740-325-1743
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist