Provider Demographics
NPI:1790490944
Name:HAYES, KELSEY (PTA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:RUDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:300 SIOUX VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1205
Mailing Address - Country:US
Mailing Address - Phone:712-225-1502
Mailing Address - Fax:
Practice Address - Street 1:300 SIOUX VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1205
Practice Address - Country:US
Practice Address - Phone:712-225-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091472225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant