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General NPI Number Information
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NPI Number | 1497901722
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Entity Type | Individual
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Provider Name | KELLY E CHILDS PT
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Gender | Female
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 5901 BROKEN SOUND PKWY
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City | BOCA RATON
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State | FL
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Zip | 33487-2773
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Country | US
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Telephone | 800-875-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 5601 SAVINA AVE
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City | DAYTON
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State | OH
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Zip | 45415-1155
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Country | US
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Telephone | 937-832-7496
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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 | PT011370
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License Number State | OH
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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 | PT31328
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License Number State | FL
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