Provider Demographics
NPI:1881933133
Name:MIKSELL, KELSEY LYNN (DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:MIKSELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LYNN
Other - Last Name:HAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1932
Mailing Address - Fax:630-928-5032
Practice Address - Street 1:2525 N ANKENY BLVD
Practice Address - Street 2:STE 101
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4714
Practice Address - Country:US
Practice Address - Phone:515-965-4594
Practice Address - Fax:515-965-4448
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist