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General NPI Number Information
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NPI Number | 1154031045
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Entity Type | Individual
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Provider Name | KELLY HAVLIN PT, DPT, MBA
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Gender | Female
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 21225 LORAIN RD
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City | CLEVELAND
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State | OH
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Zip | 44126-2120
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Country | US
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Telephone | 440-331-3180
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Fax |
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Provider Business Mailing Address
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Address Line | 1563 CORDOVA AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3603
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Country | US
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Telephone | 440-665-4473
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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 | PT019368
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License Number State | OH
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