Healthcare Provider Details

I. General information

NPI: 1730190083
Provider Name (Legal Business Name): KELLI ROSE PALMER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI JANTZI TRYON

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 PARK CENTER DR STE 200
MATTHEWS NC
28105-5082
US

IV. Provider business mailing address

710 PARK CENTER DR STE 200
MATTHEWS NC
28105-5082
US

V. Phone/Fax

Practice location:
  • Phone: 704-774-0751
  • Fax:
Mailing address:
  • Phone: 704-774-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10170
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: