Provider Demographics
NPI:1932654993
Name:MEYER, KELSEY ANNE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANNE
Last Name:MEYER
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 1:23749 133RD ST
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-2556
Mailing Address - Country:US
Mailing Address - Phone:320-630-2776
Mailing Address - Fax:
Practice Address - Street 1:221 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-1570
Practice Address - Country:US
Practice Address - Phone:320-468-7199
Practice Address - Fax:320-310-0254
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist