Provider Demographics
NPI:1336890003
Name:HUBBARD, KELSEY (DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3411
Mailing Address - Country:US
Mailing Address - Phone:601-316-7578
Mailing Address - Fax:
Practice Address - Street 1:1785 NONCONNAH BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2139
Practice Address - Country:US
Practice Address - Phone:901-344-0101
Practice Address - Fax:901-344-0107
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist