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General NPI Number Information
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NPI Number | 1134470057
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE LELLO
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Gender | Female
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 37 WOODLANDS DR
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City | WAYMART
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State | PA
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Zip | 18472-9366
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Country | US
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Telephone | 570-488-9884
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Fax |
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Provider Business Mailing Address
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Address Line | 139 E ATHERTON ST
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City | TAYLOR
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State | PA
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Zip | 18517-1801
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Country | US
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Telephone | 570-562-2260
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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 | TPTA000096
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License Number State | PA
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