Individual
KELSEY E DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 NAZARETH LN, SAINT LOUIS, MO 63129-7600
(314) 236-1073
Mailing address
6966 PERNOD AVE, SAINT LOUIS, MO 63139-2118
(314) 236-1073
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2020036611
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M4M399W07006
ANTHEM
MO
Enumeration date
12/23/2021
Last updated
12/23/2021
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