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General NPI Number Information
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NPI Number | 1972831675
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Entity Type | Individual
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Provider Name | KELSEY MAREE KIRKWOLD PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 1025 ROBERTA LN
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City | SPARKS
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State | NV
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Zip | 89431-1893
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Country | US
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Telephone | 415-533-1502
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8056
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City | TRUCKEE
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State | CA
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Zip | 96162-8056
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Country | US
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Telephone | 415-533-1502
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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 | 3010
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License Number State | NV
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