Provider Demographics
NPI:1649765728
Name:BEEDE, KELSEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BEEDE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:WORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:600 COOPER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3969
Mailing Address - Country:US
Mailing Address - Phone:469-800-2630
Mailing Address - Fax:
Practice Address - Street 1:600 COOPER DR STE 100
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3969
Practice Address - Country:US
Practice Address - Phone:469-800-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1305258225100000X
TN12622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist