Healthcare Provider Details

I. General information

NPI: 1649514399
Provider Name (Legal Business Name): KELLY SCARBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28546 STARBRIGHT BLVD
PERRYSBURG OH
43551-4686
US

IV. Provider business mailing address

953 REYNOLDS CIR
OREGON OH
43616-3485
US

V. Phone/Fax

Practice location:
  • Phone: 419-666-0935
  • Fax: 419-666-5610
Mailing address:
  • Phone: 419-698-5839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009954
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: