Healthcare Provider Details

I. General information

NPI: 1487447785
Provider Name (Legal Business Name): KELSEY JENNIFER MATTHEWS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 DR CALVIN JONES HWY STE 212
WAKE FOREST NC
27587-3106
US

IV. Provider business mailing address

616 DR CALVIN JONES HWY STE 212
WAKE FOREST NC
27587-3106
US

V. Phone/Fax

Practice location:
  • Phone: 919-673-4246
  • Fax:
Mailing address:
  • Phone: 919-673-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15048
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25271
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: