Provider Demographics
NPI:1881842185
Name:COURSEY, KELLY ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:COURSEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 EAST STATE HWY 136
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327
Mailing Address - Country:US
Mailing Address - Phone:270-273-3750
Mailing Address - Fax:270-273-3750
Practice Address - Street 1:190 EAST STATE HWY 136
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:KY
Practice Address - Zip Code:42327
Practice Address - Country:US
Practice Address - Phone:270-273-3750
Practice Address - Fax:270-273-3750
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01102225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant