MEDICARE: KELLY CHRISTENSEN

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

General Provider Information

NPI Number	:	1215584651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CHRISTENSEN

Provider Business Mailing Address
First Line	:	576 BROADHOLLOW RD
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 COLD SPRING DR
Second Line	:
City	:	SOUND BEACH
State	:	NY
Zip	:	11789-1216
Country	:	US
Telephone Number	:	631-875-2012
Fax Number	:

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

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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Directions to “ KELLY CHRISTENSEN ” Practice Location

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