MEDICARE: MS. LORI J KELLY 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 15757	CA

General Provider Information

NPI Number	:	1578651816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI J KELLY PT

Provider Business Mailing Address
First Line	:	433 SOSCOL AVE STE B191
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94559-4040
Country	:	US
Telephone Number	:	707-224-3131
Fax Number	:	707-224-2356

Provider Business Practice Location Address
First Line	:	433 SOSCOL AVE STE B191
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94559-4040
Country	:	US
Telephone Number	:	707-224-3131
Fax Number	:	707-224-2356

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/14/2024

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