Healthcare Provider Details

I. General information

NPI: 1245065671
Provider Name (Legal Business Name): KELSEY KRAUSE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CAMPUS DR NW
SUPPLY NC
28462-4096
US

IV. Provider business mailing address

943 PINE LOG RD
AIKEN SC
29803-7330
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-5861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: