Provider Demographics
NPI:1487254322
Name:FISCHER, KELSEY RENEE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEE
Last Name:FISCHER
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 1:4400 DORSET DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9317
Mailing Address - Country:US
Mailing Address - Phone:517-206-7368
Mailing Address - Fax:
Practice Address - Street 1:170 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8709
Practice Address - Country:US
Practice Address - Phone:910-715-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32583225100000X
OR64261225100000X
MI5501019793225100000X
WAPT61251777225100000X
NCP21875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist