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General NPI Number Information
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NPI Number | 1043731797
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Entity Type | Individual
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Provider Name | KELLY A PICKENS DPT
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Gender | Female
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 7341 OFFICE PARK PL STE 102
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City | MELBOURNE
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State | FL
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Zip | 32940
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Country | US
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Telephone | 321-690-6612
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Fax | 321-690-2630
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Provider Business Mailing Address
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Address Line | 24630 WASHINGTON AVE STE 200
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City | MURRIETA
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State | CA
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Zip | 92562-6177
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Country | US
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Telephone | 951-609-6336
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Fax | 951-973-7216
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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 | 05012541A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT31671
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License Number State | FL
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