Healthcare Provider Details

I. General information

NPI: 1104485531
Provider Name (Legal Business Name): ASHLEY NICHOLE KIELY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 SAXON BLVD STE 301
DELTONA FL
32725-5836
US

IV. Provider business mailing address

1200 LEXINGTON GREEN LN
SANFORD FL
32771-1013
US

V. Phone/Fax

Practice location:
  • Phone: 386-851-0901
  • Fax: 386-851-6320
Mailing address:
  • Phone: 407-322-3442
  • Fax: 407-322-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: