MEDICARE: DR. PATRICK JOHN KELLY DPT

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	034516-1	NY

General Provider Information

NPI Number	:	1821365198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK JOHN KELLY DPT

Provider Business Mailing Address
First Line	:	1841 BROADWAY RM 507
Second Line	:	SUITE 507
City	:	NEW YORK
State	:	NY
Zip	:	10023-7685
Country	:	US
Telephone Number	:	212-757-3551
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 BROADWAY RM 507
Second Line	:	SUITE 507
City	:	NEW YORK
State	:	NY
Zip	:	10023-7685
Country	:	US
Telephone Number	:	212-757-3551
Fax Number	:

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	12/01/2011

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Directions to “ DR. PATRICK JOHN KELLY DPT” Practice Location

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