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General NPI Number Information
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NPI Number | 1558845529
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Entity Type | Individual
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Provider Name | PEYTON ROSE KELLY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 09/17/2018
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Provider Practice Location Address
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Address Line | 12 EXECUTIVE PARK DR NE
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City | ATLANTA
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State | GA
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Zip | 30329-2206
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Country | US
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Telephone | 404-778-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 ANGELO CT NE
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City | ATLANTA
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State | GA
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Zip | 30319-1042
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Country | US
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Telephone | 770-315-2305
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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 | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | PT013607
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License Number State | GA
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