MEDICARE: MR. BRANDON CHRISTOPHER KELLEY DPT 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	PT033991	PA

General Provider Information

NPI Number	:	1194676056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRANDON CHRISTOPHER KELLEY DPT PT

Provider Business Mailing Address
First Line	:	140 ELMWOOD DR
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-7227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 COUNTRY CLUB PKWY
Second Line	:
City	:	SPRING CREEK
State	:	NV
Zip	:	89815-5830
Country	:	US
Telephone Number	:	177-529-6844
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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