Provider Demographics
NPI:1356606578
Name:KATA, KELSEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:KATA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 MILLWOOD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1827
Mailing Address - Country:US
Mailing Address - Phone:616-581-7963
Mailing Address - Fax:
Practice Address - Street 1:115 ATRIUM WAY
Practice Address - Street 2:SUITE 232
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6371
Practice Address - Country:US
Practice Address - Phone:803-788-8499
Practice Address - Fax:803-788-8499
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist