Provider Demographics
NPI:1457738957
Name:BARKS, KELSEY DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:DANIELLE
Last Name:BARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:DANIELLE
Other - Last Name:STAUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2956
Mailing Address - Country:US
Mailing Address - Phone:509-209-9488
Mailing Address - Fax:509-209-9489
Practice Address - Street 1:623 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2956
Practice Address - Country:US
Practice Address - Phone:509-893-4462
Practice Address - Fax:509-893-4482
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1820225100000X
WAPT60571939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist