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NPI Code Detail

MEDICARE: KELLIE ELY MSPT

MEDICARE: KELLIE ELY MSPT
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 TherapistPT012769LPA

General Provider Information

NPI Number : 1659497634
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE ELY MSPT
Provider Business Mailing Address
First Line : 937 JO JO RD
Second Line :
City : KANE
State : PA
Zip : 16735-3411
Country : US
Telephone Number : 814-837-9338
Fax Number :
Provider Business Practice Location Address
First Line : 100 HIGH POINT DR
Second Line :
City : KANE
State : PA
Zip : 16735-9704
Country : US
Telephone Number : 814-837-6706
Fax Number : 814-837-9205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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Directions to “ KELLIE ELY MSPT” Practice Location

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