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General NPI Number Information
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NPI Number | 1669705620
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Entity Type | Individual
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Provider Name | KELLEY YOUNG HAVENS P.T.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | CORNERSTONE PHYSICAL THERAPY 7145 N. CHESTNUT AVE. SUITE 105
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City | FRESNO
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State | CA
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Zip | 93720
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Country | US
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Telephone | 559-299-2244
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Fax | 559-299-2487
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Provider Business Mailing Address
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Address Line | 7145 N. CHESTNUT AVE. SUITE 105
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City | FRESNO
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State | CA
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Zip | 93720
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Country | US
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Telephone | 559-999-6147
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Fax | 559-323-9157
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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 | PT22947
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License Number State | CA
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