Provider Demographics
NPI:1952532558
Name:KELISEK, ROSALEE ANN (DPT)
Entity type:Individual
Prefix:
First Name:ROSALEE
Middle Name:ANN
Last Name:KELISEK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROSALEE
Other - Middle Name:A
Other - Last Name:CURTIS-SMYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18 E JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9510
Mailing Address - Country:US
Mailing Address - Phone:609-927-1991
Mailing Address - Fax:609-926-0075
Practice Address - Street 1:18 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9510
Practice Address - Country:US
Practice Address - Phone:609-927-1991
Practice Address - Fax:609-926-0075
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01384700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist