Healthcare Provider Details

I. General information

NPI: 1780277483
Provider Name (Legal Business Name): KELLEY ANNE STOBBS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984B LASKIN RD
VIRGINIA BEACH VA
23451-3905
US

IV. Provider business mailing address

2728 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-7615
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-6900
  • Fax: 757-425-7180
Mailing address:
  • Phone: 757-395-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305209493
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305209493
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: