Healthcare Provider Details

I. General information

NPI: 1336748680
Provider Name (Legal Business Name): KELSEY LOWE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 SGT PRENTISS DR STE A
NATCHEZ MS
39120-4142
US

IV. Provider business mailing address

20 OAKWOOD LN
NATCHEZ MS
39120-5036
US

V. Phone/Fax

Practice location:
  • Phone: 601-600-2515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA6953
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: