Healthcare Provider Details

I. General information

NPI: 1518769371
Provider Name (Legal Business Name): KEJ PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 09/11/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HAZY HOLLOW RUN
ROSWELL GA
30076-3602
US

IV. Provider business mailing address

21 HIGH TOP RD
ATLANTA GA
30328-5929
US

V. Phone/Fax

Practice location:
  • Phone: 770-780-2131
  • Fax:
Mailing address:
  • Phone: 770-780-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY JONES
Title or Position: DPT
Credential: DPT
Phone: 770-780-2131