Provider Demographics
NPI:1821736307
Name:PORTER, KELSEY JORDAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JORDAN
Last Name:PORTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 INVERNESS DR W STE 100
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5066
Mailing Address - Country:US
Mailing Address - Phone:303-694-3333
Mailing Address - Fax:303-694-9666
Practice Address - Street 1:175 INVERNESS DR W STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5069
Practice Address - Country:US
Practice Address - Phone:303-694-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13317932251S0007X
COPTL.0018452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports