Provider Demographics
NPI:1851496301
Name:KELSESKY, DARLENE M (PT)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:M
Last Name:KELSESKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 STONE BRIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8282
Mailing Address - Country:US
Mailing Address - Phone:770-926-9112
Mailing Address - Fax:770-926-4259
Practice Address - Street 1:1505 STONE BRIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:770-926-9112
Practice Address - Fax:770-926-4259
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q61370Medicare UPIN
65BBDLZMedicare ID - Type Unspecified