=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649418658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY ANN CAULEY DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2009
-----------------------------------------------------
Last Update Date | 11/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 SHANNONDELL DR
-----------------------------------------------------
City | AUDUBON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19403-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-728-5607
-----------------------------------------------------
Fax | 610-728-5323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 188 WILLIAM PENN DR
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19403-5206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-322-2068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | PT019605
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------