Healthcare Provider Details

I. General information

NPI: 1255180774
Provider Name (Legal Business Name): KELSEY HARBOLD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LINCOLN AVE STE 107
CHARLEROI PA
15022-2451
US

IV. Provider business mailing address

4325 RTE 51 N
ROSTRAVER TWP PA
15012-3535
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4886
  • Fax: 724-483-0519
Mailing address:
  • Phone: 724-565-5806
  • Fax: 724-483-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT025612
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: