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General NPI Number Information
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NPI Number | 1679323299
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Entity Type | Individual
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Provider Name | GLEN AARON KELLY
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Gender | Male
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 3802 WADE COBLE DR
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City | BURLINGTON
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State | NC
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Zip | 27215-9765
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Country | US
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Telephone | 336-538-1522
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Fax |
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Provider Business Mailing Address
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Address Line | 710 WAGONER RD
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City | ELON
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State | NC
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Zip | 27244-9222
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Country | US
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Telephone | 919-423-7985
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A4734
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License Number State | NC
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