MEDICARE: DENISE MICHELLE KELLEY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	22949	CA

General Provider Information

NPI Number	:	1013964956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MICHELLE KELLEY PT

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	CEDAR RIDGE
State	:	CA
Zip	:	95924-0010
Country	:	US
Telephone Number	:	530-277-2160
Fax Number	:

Provider Business Practice Location Address
First Line	:	569 SEARLS AVE
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-3063
Country	:	US
Telephone Number	:	530-478-1933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	10/04/2016

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Directions to “ DENISE MICHELLE KELLEY PT” Practice Location

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