Healthcare Provider Details

I. General information

NPI: 1922733252
Provider Name (Legal Business Name): KELLY J DALY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N ENTRANCE AVE
KANKAKEE IL
60901-2026
US

IV. Provider business mailing address

801 LOUISE LN
PEOTONE IL
60468-9413
US

V. Phone/Fax

Practice location:
  • Phone: 815-936-4570
  • Fax:
Mailing address:
  • Phone: 815-351-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160001722
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: