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General NPI Number Information
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NPI Number | 1932090537
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH KELLY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 2736 MEDINA RD STE 108
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City | MEDINA
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State | OH
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Zip | 44256-9801
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Country | US
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Telephone | 330-867-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 134 3RD ST NW
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City | NEW PHILADELPHIA
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State | OH
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Zip | 44663-3761
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Country | US
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Telephone | 330-987-3884
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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 | PT021871
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License Number State | OH
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