Healthcare Provider Details

I. General information

NPI: 1952634271
Provider Name (Legal Business Name): STEPHANIE CARTER KELLEY PT, MS, PHD, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE KAY CARTER PT

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 OLENTANGY RIVER ROAD
COLUMBUS OH
43235
US

IV. Provider business mailing address

7710 OLENTANGY RIVER ROAD
COLUMBUS OH
43235
US

V. Phone/Fax

Practice location:
  • Phone: 614-841-3900
  • Fax: 614-841-3930
Mailing address:
  • Phone: 614-841-3900
  • Fax: 614-841-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: