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NPI Code Detail

MEDICARE: DR. KELSIE MARIE BUSTAMANTE PT, DPT

MEDICARE: DR. KELSIE MARIE BUSTAMANTE PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist05016249AIN

General Provider Information

NPI Number : 1518818194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELSIE MARIE BUSTAMANTE PT, DPT
Provider Business Mailing Address
First Line : 468 S CLINTON BLVD
Second Line :
City : BUNKER HILL
State : IN
Zip : 46914-9602
Country : US
Telephone Number : 765-865-8705
Fax Number :
Provider Business Practice Location Address
First Line : 1558 E BOULEVARD STE E
Second Line :
City : KOKOMO
State : IN
Zip : 46902-2587
Country : US
Telephone Number : 765-865-8705
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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