Healthcare Provider Details

I. General information

NPI: 1730007709
Provider Name (Legal Business Name): MARY BETH KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PARKWOOD AVE
CHATTANOOGA TN
37404-1730
US

IV. Provider business mailing address

104 INVERNESS DR
SIGNAL MOUNTAIN TN
37377-2050
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-1533
  • Fax:
Mailing address:
  • Phone: 423-624-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number906
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: