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NPI Code Detail

MEDICARE: KELLY TODD

MEDICARE: KELLY TODD
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
1208100000XPhysical Medicine & Rehabilitation PhysicianPT31476FL

General Provider Information

NPI Number : 1366968620
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY TODD
Provider Business Mailing Address
First Line : 12424 LAKE VALLEY DR
Second Line :
City : CLERMONT
State : FL
Zip : 34711-6712
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 627 8TH ST
Second Line :
City : CLERMONT
State : FL
Zip : 34711-2159
Country : US
Telephone Number : 352-243-9341
Fax Number : 352-242-8766
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2017
Last Update Date : 02/23/2021

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Directions to “ KELLY TODD ” Practice Location

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