Healthcare Provider Details

I. General information

NPI: 1114969961
Provider Name (Legal Business Name): RICHARD LANCE KELLY MPT,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 20TH ST NW
WASHINGTON DC
20036
US

IV. Provider business mailing address

15945 PAYNES FARM DR RICHARD.L.KELLY@MEDSTAR.NET
HAYMARKET VA
20169-3406
US

V. Phone/Fax

Practice location:
  • Phone: 202-416-2110
  • Fax:
Mailing address:
  • Phone: 706-593-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6446
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number871829
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: