Provider Demographics
NPI:1366185019
Name:CLEVER, KELSEY (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CLEVER
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 E FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1400
Mailing Address - Country:US
Mailing Address - Phone:717-812-5601
Mailing Address - Fax:
Practice Address - Street 1:73 E FORREST AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1400
Practice Address - Country:US
Practice Address - Phone:717-812-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist