Basic Information
| Provider Information | |||||||||
| NPI: | 1194369132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAROLAN | ||||||||
| FirstName: | KELSEY | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1706 WASHINGTON AVE APT 819 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631031761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478632177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 542 16TH ST | ||||||||
| Address2: | |||||||||
| City: | RAWLINS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 823015241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073242759 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2019 | ||||||||
| LastUpdateDate: | 11/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.