Healthcare Provider Details

I. General information

NPI: 1922353192
Provider Name (Legal Business Name): KELSEY MIMS DANIELS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 E ATLANTA RD STE 2
ELLENWOOD GA
30294-2780
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 678-782-3609
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010711
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: