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NPI Code Detail

MEDICARE: MRS. JESSICA HART KELLEY PT, DPT

MEDICARE:  MRS. JESSICA HART KELLEY  PT, DPT
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
1225100000XPhysical Therapist1208190TX

General Provider Information

NPI Number : 1154676930
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA HART KELLEY PT, DPT
Provider Business Mailing Address
First Line : 6404 ROLLING HILL RD
Second Line :
City : THE COLONY
State : TX
Zip : 75056-3736
Country : US
Telephone Number : 806-392-4294
Fax Number :
Provider Business Practice Location Address
First Line : 6404 ROLLING HILL RD
Second Line :
City : THE COLONY
State : TX
Zip : 75056-3736
Country : US
Telephone Number : 806-392-4294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2012
Last Update Date : 03/17/2014

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Directions to “ MRS. JESSICA HART KELLEY PT, DPT” Practice Location

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