Healthcare Provider Details

I. General information

NPI: 1487589669
Provider Name (Legal Business Name): KELLY DEWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY DADDONA

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SHANNONDELL DR
AUDUBON PA
19403-5615
US

IV. Provider business mailing address

1222 MERRYBROOK RD
COLLEGEVILLE PA
19426-1529
US

V. Phone/Fax

Practice location:
  • Phone: 610-728-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013510L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: