MEDICARE: MS. CATHY ROSE 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	172M00000X	Mechanotherapist	20060	FL

General Provider Information

NPI Number	:	1659509917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHY ROSE KELLY

Provider Business Mailing Address
First Line	:	4508 CROTON DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5166
Country	:	US
Telephone Number	:	727-849-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	4508 CROTON DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5166
Country	:	US
Telephone Number	:	727-849-1707
Fax Number	:

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	06/25/2009

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