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General NPI Number Information
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NPI Number | 1114969961
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Entity Type | Individual
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Provider Name | RICHARD LANCE KELLY MPT,ATC
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 1120 20TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20036
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Country | US
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Telephone | 202-416-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 15945 PAYNES FARM DR RICHARD.L.KELLY@MEDSTAR.NET
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City | HAYMARKET
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State | VA
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Zip | 20169-3406
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Country | US
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Telephone | 706-593-7719
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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 | 6446
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 871829
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License Number State | DC
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