Provider Demographics
NPI:1477983872
Name:VICKERS, KELSEY (DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:VICKERS
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 1:1 CAMERON HILL CIR,
Mailing Address - Street 2:BLDG 1, FIRST FLOOR
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-0001
Mailing Address - Country:US
Mailing Address - Phone:423-535-4000
Mailing Address - Fax:423-535-1506
Practice Address - Street 1:1 CAMERON HILL CIR
Practice Address - Street 2:BUILDING 1, FIRST FLOOR
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402
Practice Address - Country:US
Practice Address - Phone:423-535-4000
Practice Address - Fax:423-535-1506
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare PIN