Provider Demographics
NPI:1447685946
Name:DEVRIES, KELSEA ROSE (PT)
Entity type:Individual
Prefix:
First Name:KELSEA
Middle Name:ROSE
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELSEA
Other - Middle Name:ROSE
Other - Last Name:LUNDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5004 SILVERBELL CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3697
Mailing Address - Country:US
Mailing Address - Phone:312-720-8527
Mailing Address - Fax:
Practice Address - Street 1:70 SHERRY LN STE 201
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3282
Practice Address - Country:US
Practice Address - Phone:443-295-8134
Practice Address - Fax:443-295-8139
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35901225100000X
NC14277225100000X
MD26915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist