Healthcare Provider Details

I. General information

NPI: 1063814705
Provider Name (Legal Business Name): KELLY BRITT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 ERIE AVE STE 6
CINCINNATI OH
45208-1656
US

IV. Provider business mailing address

2605 STREAMSIDE CT
CINCINNATI OH
45230-2448
US

V. Phone/Fax

Practice location:
  • Phone: 513-509-9716
  • Fax:
Mailing address:
  • Phone: 513-509-9716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-7064
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-7064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: