Provider Demographics
NPI:1356782379
Name:TRACEY, KELSEY MARIE (PT,)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:TRACEY
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8702
Mailing Address - Country:US
Mailing Address - Phone:330-335-4200
Mailing Address - Fax:330-335-7131
Practice Address - Street 1:145 SMOKERISE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8702
Practice Address - Country:US
Practice Address - Phone:330-335-4200
Practice Address - Fax:330-335-7131
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist