Provider Demographics
NPI:1124668736
Name:KIENZLE, KELSEY ELIZABETH (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:KIENZLE
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-1120
Mailing Address - Country:US
Mailing Address - Phone:610-237-6410
Mailing Address - Fax:
Practice Address - Street 1:500 16TH AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1120
Practice Address - Country:US
Practice Address - Phone:610-237-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-11
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0075442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty