Provider Demographics
NPI:1013587229
Name:KAZMIERCZAK, KELSI MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:MICHELLE
Last Name:KAZMIERCZAK
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 1:524 ABERDEEN DR APT 202
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4016
Mailing Address - Country:US
Mailing Address - Phone:910-523-0987
Mailing Address - Fax:
Practice Address - Street 1:102 MASON FARM RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4617
Practice Address - Country:US
Practice Address - Phone:784-215-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist