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NPI Code Detail

MEDICARE: RONALD KELLY

MEDICARE:   RONALD  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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1194027599
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD KELLY
Provider Business Mailing Address
First Line : 3019 SEASONS AVE
Second Line :
City : HENDERSON
State : NV
Zip : 89074-6992
Country : US
Telephone Number : 702-423-7242
Fax Number :
Provider Business Practice Location Address
First Line : 3019 SEASONS AVE
Second Line :
City : HENDERSON
State : NV
Zip : 89074-6992
Country : US
Telephone Number : 702-423-7242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2010
Last Update Date : 11/17/2010

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Directions to “ RONALD KELLY ” Practice Location

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