Healthcare Provider Details

I. General information

NPI: 1649137316
Provider Name (Legal Business Name): KELSAY N MARES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 E MAGNOLIA ST
VISALIA CA
93292
US

IV. Provider business mailing address

4235 E MAGNOLIA ST
VISALIA CA
93292
US

V. Phone/Fax

Practice location:
  • Phone: 559-740-9246
  • Fax:
Mailing address:
  • Phone: 559-740-9246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: