Provider Demographics
NPI:1174926000
Name:KELSO, VALERIE ELAINE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ELAINE
Last Name:KELSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 RUFE SNOW DR STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6080
Mailing Address - Country:US
Mailing Address - Phone:817-350-9457
Mailing Address - Fax:682-334-6272
Practice Address - Street 1:5757 RUFE SNOW DR STE B
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6080
Practice Address - Country:US
Practice Address - Phone:817-350-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT117848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist