Provider Demographics
NPI:1538570122
Name:BRIGHAM, KELSIE L (DPT)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:L
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:L
Other - Last Name:KOESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 75345
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67275-0345
Mailing Address - Country:US
Mailing Address - Phone:316-259-2407
Mailing Address - Fax:
Practice Address - Street 1:7335 W 33RD ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9368
Practice Address - Country:US
Practice Address - Phone:316-866-7067
Practice Address - Fax:844-788-4005
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-04875OtherKANSAS STATE BOARD OF HEALING ARTS