Provider Demographics
NPI:1952013583
Name:PACK, KELSEY (PT,DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PACK
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:REISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9804 STATE ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8983
Mailing Address - Country:US
Mailing Address - Phone:740-821-6570
Mailing Address - Fax:
Practice Address - Street 1:1112 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4161
Practice Address - Country:US
Practice Address - Phone:740-354-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist