MEDICARE: KELLY HADLEY 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	PT24258	FL

General Provider Information

NPI Number	:	1962722777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY HADLEY PT

Provider Business Mailing Address
First Line	:	11162 SW WYNDHAM WAY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-2752
Country	:	US
Telephone Number	:	772-801-9953
Fax Number	:	855-894-7272

Provider Business Practice Location Address
First Line	:	11162 SW WYNDHAM WAY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-2752
Country	:	US
Telephone Number	:	772-801-9953
Fax Number	:	855-894-7272

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	09/09/2014

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