Provider Demographics
NPI:1013340736
Name:PAOLUCCI, KELSEY R (PT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:R
Last Name:PAOLUCCI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:R
Other - Last Name:KALLIOINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2135 MARLBORO CT
Mailing Address - Street 2:APT 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5034
Mailing Address - Country:US
Mailing Address - Phone:831-588-2210
Mailing Address - Fax:
Practice Address - Street 1:9000 SOQUEL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2097
Practice Address - Country:US
Practice Address - Phone:831-464-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist