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NPI Code Detail

MEDICARE: LISA KELLY PT,CERT.MDT,COMT

MEDICARE: LISA KELLY PT,CERT.MDT,COMT
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
1174400000XSpecialistPT009484-LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT009484-LOTHERPAPT LICENSE NUMBER

General Provider Information

NPI Number : 1134120116
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KELLY PT,CERT.MDT,COMT
Provider Business Mailing Address
First Line : 28 COUNTRY LN
Second Line :
City : GLEN MILLS
State : PA
Zip : 19342-1436
Country : US
Telephone Number : 610-724-8708
Fax Number :
Provider Business Practice Location Address
First Line : 420 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1568
Country : US
Telephone Number : 215-629-1270
Fax Number : 215-629-5531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 10/13/2022

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Directions to “ LISA KELLY PT,CERT.MDT,COMT” Practice Location

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