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NPI Code Detail

MEDICARE: ANDREW D KELLY PT

MEDICARE: ANDREW D KELLY PT
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
1225100000XPhysical Therapist10994WI

General Provider Information

NPI Number : 1508025347
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW D KELLY PT
Provider Business Mailing Address
First Line : 8201 MISH KO SWEN DR
Second Line :
City : CRANDON
State : WI
Zip : 54520-8631
Country : US
Telephone Number : 715-478-4300
Fax Number :
Provider Business Practice Location Address
First Line : 8201 MISH KO SWEN DR
Second Line :
City : CRANDON
State : WI
Zip : 54520-8631
Country : US
Telephone Number : 715-478-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2008
Last Update Date : 07/15/2015

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