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NPI Code Detail

MEDICARE: KELLY TRAN PT

MEDICARE: KELLY TRAN 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 Therapist070027804IL

General Provider Information

NPI Number : 1548040868
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY TRAN PT
Provider Business Mailing Address
First Line : 3113 W LAWRENCE AVE APT 202
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3656
Country : US
Telephone Number : 312-608-1001
Fax Number :
Provider Business Practice Location Address
First Line : 4657 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2024
Country : US
Telephone Number : 773-989-6472
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2023
Last Update Date : 12/17/2025

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Directions to “ KELLY TRAN PT” Practice Location

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