Healthcare Provider Details

I. General information

NPI: 1184545204
Provider Name (Legal Business Name): KELSEY PIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TABERNACLE RD
MEDFORD NJ
08055-9732
US

IV. Provider business mailing address

590 SWEDESBORO RD
MONROEVILLE NJ
08343-4629
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-7544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00356100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: