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NPI Code Detail

MEDICARE: MICHAEL KELLEY PT

MEDICARE: MICHAEL 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
1225100000XPhysical Therapist070017482IL

General Provider Information

NPI Number : 1477446144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KELLEY PT
Provider Business Mailing Address
First Line : 4661 N KASSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-4231
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 836 W WELLINGTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5147
Country : US
Telephone Number : 773-296-7450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2025
Last Update Date : 06/02/2025

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