Healthcare Provider Details

I. General information

NPI: 1215847991
Provider Name (Legal Business Name): BAILEY JAMES KELLETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11935 W 143RD ST
ORLAND PARK IL
60467-7218
US

IV. Provider business mailing address

11935 W 143RD ST
ORLAND PARK IL
60467-7218
US

V. Phone/Fax

Practice location:
  • Phone: 708-645-4340
  • Fax:
Mailing address:
  • Phone: 708-645-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070040787
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: