Healthcare Provider Details

I. General information

NPI: 1467652594
Provider Name (Legal Business Name): KELLEY HACKLER HUTTO P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6347 PICKNEY HILL RD
TALLAHASSEE FL
32312-1590
US

IV. Provider business mailing address

6347 PICKNEY HILL RD
TALLAHASSEE FL
32312-1590
US

V. Phone/Fax

Practice location:
  • Phone: 850-668-1857
  • Fax: 850-668-1857
Mailing address:
  • Phone: 850-668-1857
  • Fax: 850-668-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT13349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: