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NPI Code Detail

MEDICARE: CAITLIN MARIE KELLEY PT, DPT

MEDICARE: CAITLIN MARIE 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 TherapistTX

General Provider Information

NPI Number : 1467005637
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAITLIN MARIE KELLEY PT, DPT
Provider Business Mailing Address
First Line : PO BOX 150862
Second Line :
City : ARLINGTON
State : TX
Zip : 76015-6862
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4750 BRYANT IRVIN RD N
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7641
Country : US
Telephone Number : 817-923-9000
Fax Number : 817-923-9033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2019
Last Update Date : 07/17/2019

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