Healthcare Provider Details

I. General information

NPI: 1639007404
Provider Name (Legal Business Name): KELLY SHEA PT, DPT, CSRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S POTOMAC ST STE 114
AURORA CO
80012-4529
US

IV. Provider business mailing address

17 MESSIG RD
CLINTON NJ
08809-1241
US

V. Phone/Fax

Practice location:
  • Phone: 303-745-6717
  • Fax:
Mailing address:
  • Phone: 908-752-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number40QA02222400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: