Healthcare Provider Details

I. General information

NPI: 1326962135
Provider Name (Legal Business Name): KELSEY GRACE GOERTZEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

352 E HOOD AVE STE 106
SISTERS OR
97759-1619
US

IV. Provider business mailing address

20766 NE SIERRA DR
BEND OR
97701-7174
US

V. Phone/Fax

Practice location:
  • Phone: 541-904-4427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number66199
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: