Provider Demographics
NPI:1235505934
Name:CHERWIN, KELCEY (DPT)
Entity type:Individual
Prefix:
First Name:KELCEY
Middle Name:
Last Name:CHERWIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-9146
Mailing Address - Country:US
Mailing Address - Phone:214-934-5486
Mailing Address - Fax:623-551-5078
Practice Address - Street 1:275 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-9146
Practice Address - Country:US
Practice Address - Phone:214-934-5486
Practice Address - Fax:623-551-5078
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist