MEDICARE: JULIE KELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	5502003762	MI

General Provider Information

NPI Number	:	1093568792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE KELLY

Provider Business Mailing Address
First Line	:	3801 CANADA RD
Second Line	:
City	:	BIRCH RUN
State	:	MI
Zip	:	48415-9043
Country	:	US
Telephone Number	:	989-326-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 WESTSIDE SAGINAW RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9325
Country	:	US
Telephone Number	:	989-667-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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Directions to “ JULIE KELLY ” Practice Location

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