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1770564767

NPI Code Detail

MEDICARE: MRS. CHRISTINA MARIE KELLEIGH MPT

MEDICARE: MRS. CHRISTINA MARIE KELLEIGH MPT

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	2251P0200X	Pediatric Physical Therapist	11549	NC
2	225000000X	Orthotic Fitter
3	225100000X	Physical Therapist	11549	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7384345	OTHER		AETNA
2	4980093	OTHER		VIRGINIA PREMIER HEALTH
3	35062	OTHER	VA	OPTIMA
4	11230494	OTHER		CAQH
5	223302	OTHER	NC	MEDCOST
6	870146	OTHER	NC	UNITED HEALTHCARE/OPTUM HEALTH
7	436752	OTHER		ANTHEM BLUE CROSS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	0682U	OTHER	NC	BCBS NC
10	6400313	OTHER	VA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1770564767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA MARIE KELLEIGH MPT

Provider Business Mailing Address
First Line	:	1519 PORTSMOUTH PL
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-9251
Country	:	US
Telephone Number	:	910-899-2537
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 WRIGHTSVILLE AVE STE 120
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6256
Country	:	US
Telephone Number	:	910-679-8385
Fax Number	:	910-679-8387

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	01/22/2020

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Directions to “ MRS. CHRISTINA MARIE KELLEIGH MPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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