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General NPI Number Information
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NPI Number | 1205334869
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Entity Type | Individual
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Provider Name | KELLY GAFNER
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Gender | Female
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 9404 PERIMETER STATION DR
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City | CHARLOTTE
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State | NC
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Zip | 28216-4468
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Country | US
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Telephone | 301-367-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 9404 PERIMETER STATION DR
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City | CHARLOTTE
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State | NC
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Zip | 28216-4468
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Country | US
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Telephone |
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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 | PT025602
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License Number State | VA
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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 | 235210576
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT17470
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License Number State | NC
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