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NPI Code Detail

MEDICARE: JAMES KELLEY PT

MEDICARE: JAMES 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 Therapist005700NY

General Provider Information

NPI Number : 1508087891
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES KELLEY PT
Provider Business Mailing Address
First Line : 3137 WOODLAND CT N
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-1154
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3137 WOODLAND CT N
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-1154
Country : US
Telephone Number : 716-694-1994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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