MEDICARE: KELSY THANASIU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA102182	FL

General Provider Information

NPI Number	:	1013749654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSY THANASIU

Provider Business Mailing Address
First Line	:	820 W 7TH ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7504
Country	:	US
Telephone Number	:	386-690-1750
Fax Number	:	386-310-8075

Provider Business Practice Location Address
First Line	:	3821 WOODBRIAR TRL STE 3
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-9611
Country	:	US
Telephone Number	:	386-265-1579
Fax Number	:	386-310-8075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/14/2024

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Directions to “ KELSY THANASIU ” Practice Location

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