Healthcare Provider Details

I. General information

NPI: 1558592469
Provider Name (Legal Business Name): JAMES JEFFREY KELLY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 LITTLESTOWN PIKE SUITE A3
WESTMINSTER MD
21157-3007
US

IV. Provider business mailing address

660 WHISPERING MEADOWS CT
WESTMINSTER MD
21158-8852
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-6858
  • Fax: 410-751-8999
Mailing address:
  • Phone: 410-871-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3387
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: