Provider Demographics
NPI:1356543243
Name:KELO, SUSAN HESS (MSPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HESS
Last Name:KELO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 KINTAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5182
Mailing Address - Country:US
Mailing Address - Phone:804-882-6137
Mailing Address - Fax:804-425-4545
Practice Address - Street 1:12212 BRANDERS CREEK RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1626
Practice Address - Country:US
Practice Address - Phone:804-425-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist