Healthcare Provider Details

I. General information

NPI: 1336915909
Provider Name (Legal Business Name): KELLY BEDFORD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 BUNKER HILL RD
MIDDLETOWN DE
19709-9026
US

IV. Provider business mailing address

509 SWANSEA DR
MIDDLETOWN DE
19709-0207
US

V. Phone/Fax

Practice location:
  • Phone: 302-378-5135
  • Fax:
Mailing address:
  • Phone: 302-545-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000574
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: