MEDICARE: KELLY SHEATS

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	PT016087	GA

General Provider Information

NPI Number	:	1598645269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY SHEATS

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 LAUREL CANYON VILLAGE CIR STE 116
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-4680
Country	:	US
Telephone Number	:	943-400-2250
Fax Number	:	943-400-2249

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

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	04/07/2026

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Directions to “ KELLY SHEATS ” Practice Location

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