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General NPI Number Information
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NPI Number | 1508468851
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Entity Type | Individual
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Provider Name | KELSEY WRIGHT
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Gender | Female
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 2136 STATELINE RD W STE B-C
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1210
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Country | US
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Telephone | 901-335-4135
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Fax |
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Provider Business Mailing Address
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Address Line | 7321 VAIDEN RD
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City | HERNANDO
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State | MS
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Zip | 38632-9176
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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