Provider Demographics
NPI:1356643803
Name:KELINSKE, MIRANDA (PT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:KELINSKE
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 1:3037 PINTO LOOP
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-7407
Mailing Address - Country:US
Mailing Address - Phone:570-885-0965
Mailing Address - Fax:205-755-3175
Practice Address - Street 1:5 BON AIR RD
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1143
Practice Address - Country:US
Practice Address - Phone:415-924-8900
Practice Address - Fax:205-683-2468
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178189174400000X
CA293158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty