Healthcare Provider Details

I. General information

NPI: 1194223420
Provider Name (Legal Business Name): LAUREN KELLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 RAINTREE RD STE D
CHESAPEAKE VA
23321-3749
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-4241
  • Fax: 757-484-4487
Mailing address:
  • Phone: 630-575-6200
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217264
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: