Healthcare Provider Details

I. General information

NPI: 1366351660
Provider Name (Legal Business Name): KELSEY ALEXANDRA TARBRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BEDFORD ST STE 202
LEXINGTON MA
02420-4550
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600 STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 781-541-5111
  • Fax:
Mailing address:
  • Phone: 630-296-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number90049
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL90049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: