Healthcare Provider Details

I. General information

NPI: 1720396724
Provider Name (Legal Business Name): KELSEY ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NW CENTRAL AVE
AMITE LA
70422
US

IV. Provider business mailing address

215 NW CENTRAL AVE
AMITE LA
70422
US

V. Phone/Fax

Practice location:
  • Phone: 985-747-3422
  • Fax: 985-747-3424
Mailing address:
  • Phone: 985-747-3422
  • Fax: 985-747-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number02637
License Number StateLA

VIII. Authorized Official

Name: BRENNAN KELSEY
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 985-747-3422