MEDICARE: MS. GLORIA ANN KELLEY P.T.

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	PT 00001020	WA

General Provider Information

NPI Number	:	1285925743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA ANN KELLEY P.T.

Provider Business Mailing Address
First Line	:	PO BOX 145
Second Line	:
City	:	SPANGLE
State	:	WA
Zip	:	99031-0145
Country	:	US
Telephone Number	:	509-245-3377
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 W. SECOND
Second Line	:
City	:	SPANGLE
State	:	WA
Zip	:	99031-0145
Country	:	US
Telephone Number	:	509-245-3377
Fax Number	:

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

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	05/02/2011

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