Provider Demographics
NPI:1942846407
Name:HIDALGO, KELCEY AGUIRRE (PT)
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:AGUIRRE
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 VIRGINIA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5704
Mailing Address - Country:US
Mailing Address - Phone:877-295-3747
Mailing Address - Fax:
Practice Address - Street 1:1565 VIRGINIA RANCH RD
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5704
Practice Address - Country:US
Practice Address - Phone:775-782-3100
Practice Address - Fax:253-631-3899
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60645613225100000X
NV4585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist