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General NPI Number Information
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NPI Number | 1003921719
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Entity Type | Individual
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Provider Name | BRYAN DAVID KELLY PT, MS
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 185 ROUTE 312 SUITE 301B
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City | BREWSTER
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State | NY
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Zip | 10509-2337
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Country | US
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Telephone | 845-279-9288
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Fax |
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Provider Business Mailing Address
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Address Line | 89 FIRETHORN DR
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City | WAPPINGERS FALLS
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State | NY
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Zip | 12590-7511
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Country | US
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Telephone | 845-831-6911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 021446-1
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License Number State | NY
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