=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336136100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN ANN KELLY D.P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1924 TAPPAHANNOCK BLVD
-----------------------------------------------------
City | TAPPAHANNOCK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22560-9352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-445-1015
-----------------------------------------------------
Fax | 804-445-1435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 606
-----------------------------------------------------
City | TAPPAHANNOCK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22560-0606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-445-1015
-----------------------------------------------------
Fax | 804-445-1435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305204143
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------