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General NPI Number Information
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NPI Number | 1700963477
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Entity Type | Individual
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Provider Name | KELLY DERUVO DPT
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 148 MAIN ST
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City | KINGSTON
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State | NH
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Zip | 03848-3222
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Country | US
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Telephone | 516-594-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 17 PARSONS WAY
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City | KINGSTON
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State | NH
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Zip | 03848-3657
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Country | US
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Telephone |
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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 | 1223120
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License Number State | TX
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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 | 026447-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4194
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License Number State | NH
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