Healthcare Provider Details

I. General information

NPI: 1932023199
Provider Name (Legal Business Name): JULIANN KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 VILLAGE CENTER BLVD STE 100
MYRTLE BEACH SC
29579-6706
US

IV. Provider business mailing address

PO BOX 414
WHITEWRIGHT TX
75491-0414
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax: 843-353-3461
Mailing address:
  • Phone: 903-815-5442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061444T
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1408841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: