MEDICARE: MR. MICHAEL J KELO 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
1	225100000X	Physical Therapist	2305002847	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578524203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J KELO PT

Provider Business Mailing Address
First Line	:	11801 BRAYSTONE LN
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23838-5303
Country	:	US
Telephone Number	:	804-366-8518
Fax Number	:	804-778-4522

Provider Business Practice Location Address
First Line	:	11928 IRON BRIDGE PLZ
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1441
Country	:	US
Telephone Number	:	804-366-8518
Fax Number	:	804-778-4522

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	01/29/2009

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