=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073452959
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY EVERSON PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 S 13TH AVE
-----------------------------------------------------
City | VIRGINIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55792-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-741-9201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 13TH AVE W
-----------------------------------------------------
City | EVELETH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55734-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-741-9201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 11891
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------