Healthcare Provider Details

I. General information

NPI: 1942807896
Provider Name (Legal Business Name): JOSEPH MICHAEL KELLY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6069 HIGHLAND DR
HOLLADAY UT
84121
US

IV. Provider business mailing address

6069 HIGHLAND DR
HOLLADAY UT
84121
US

V. Phone/Fax

Practice location:
  • Phone: 801-944-1209
  • Fax: 801-274-1180
Mailing address:
  • Phone: 801-944-1209
  • Fax: 801-274-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25089
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13666417-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: