MEDICARE: KEVIN D KELLEY 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	PT-006393	KY
2	225100000X	Physical Therapist	PT-014669	OH

General Provider Information

NPI Number	:	1447675129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN D KELLEY PT

Provider Business Mailing Address
First Line	:	1 NEUMANN WAY
Second Line	:	BLDG. 750
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1915
Country	:	US
Telephone Number	:	513-853-8900
Fax Number	:	513-853-8998

Provider Business Practice Location Address
First Line	:	1 NEUMANN WAY
Second Line	:	BLDG. 750
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1915
Country	:	US
Telephone Number	:	513-853-8900
Fax Number	:	513-853-8998

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

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	11/16/2016

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