MEDICARE: MARY 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	PT003228L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2485028	OTHER	PA	AETNA HMO
2	7313174	OTHER	PA	AETNA PPO/POS
3	KE563880	OTHER	PA	PA BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	072237	OTHER	PA	FIRST PRIORITY HEALTH

General Provider Information

NPI Number	:	1801861067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KELLY PT

Provider Business Mailing Address
First Line	:	86 N OLD TURNPIKE RD
Second Line	:
City	:	DRUMS
State	:	PA
Zip	:	18222-1916
Country	:	US
Telephone Number	:	570-788-5357
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 S OLD TURNPIKE RD
Second Line	:
City	:	DRUMS
State	:	PA
Zip	:	18222-1726
Country	:	US
Telephone Number	:	570-788-7427
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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Directions to “ MARY KELLY PT” Practice Location

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