Healthcare Provider Details

I. General information

NPI: 1598683260
Provider Name (Legal Business Name): KELSIE RAYNE BOWLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PITCOCK LN
CELINA TN
38551-4058
US

IV. Provider business mailing address

3820 HURRICANE RD
HUNTSVILLE TN
37756-3543
US

V. Phone/Fax

Practice location:
  • Phone: 931-243-3139
  • Fax:
Mailing address:
  • Phone: 423-701-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8692
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: