Healthcare Provider Details

I. General information

NPI: 1508795519
Provider Name (Legal Business Name): ALEXSANDER DAMIEN KELSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W JACKSON BLVD LBBY 1
CHICAGO IL
60606-6951
US

IV. Provider business mailing address

1261 W ARGYLE ST APT 110
CHICAGO IL
60640-3544
US

V. Phone/Fax

Practice location:
  • Phone: 312-407-0143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.039853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: