Provider Demographics
NPI:1801467865
Name:KNECHT, KELSEY RAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:KNECHT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 E 10TH ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110
Mailing Address - Country:US
Mailing Address - Phone:605-351-7861
Mailing Address - Fax:
Practice Address - Street 1:6800 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6026
Practice Address - Country:US
Practice Address - Phone:605-504-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist