Healthcare Provider Details

I. General information

NPI: 1659718690
Provider Name (Legal Business Name): KELLY MARIE HOLTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MARIE SUFKA DPT

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 DILEY RD STE B
CANAL WINCHESTER OH
43110-7758
US

IV. Provider business mailing address

340 POLARIS PKWY
WESTERVILLE OH
43082-7971
US

V. Phone/Fax

Practice location:
  • Phone: 614-545-7939
  • Fax: 614-388-9812
Mailing address:
  • Phone: 614-839-2300
  • Fax: 614-839-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: