Basic Information
| Provider Information | |||||||||
| NPI: | 1285282632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODBURY | ||||||||
| FirstName: | KELSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 MEDICAL CENTER PKWY | ||||||||
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| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043308160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076213639 | ||||||||
| FaxNumber: | 2076261827 | ||||||||
| Practice Location | |||||||||
| Address1: | 2263 ROUTE 2 | ||||||||
| Address2: | |||||||||
| City: | HERMON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044010605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078489009 | ||||||||
| FaxNumber: | 2074042562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2019 | ||||||||
| LastUpdateDate: | 12/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT4664 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.