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General NPI Number Information
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NPI Number | 1023145661
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Entity Type | Individual
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Provider Name | MR. DAVID KELLEY
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 TRACY WAY
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City | CHARLESTON
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State | WV
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Zip | 25311
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Country | US
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Telephone | 304-388-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 909 VALLEY VIEW DRIVE
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309
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Country | US
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Telephone | 304-388-4900
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 000097
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License Number State | WV
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