Healthcare Provider Details

I. General information

NPI: 1366422636
Provider Name (Legal Business Name): KELLY ABRAMS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KELLY WILLIAMS PT

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MARK TREE RD
CENTEREACH NY
11720-2221
US

IV. Provider business mailing address

3 UPPER CROSS WAY
SHOREHAM NY
11786-1457
US

V. Phone/Fax

Practice location:
  • Phone: 631-467-4235
  • Fax: 631-467-2655
Mailing address:
  • Phone: 631-467-4235
  • Fax: 631-467-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025564-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: