Provider Demographics
NPI:1447211826
Name:BIGELOW, KELLY MYOTT (PT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MYOTT
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MYOTT
Other - Last Name:MARCHETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17512 SHADY RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6236
Mailing Address - Country:US
Mailing Address - Phone:302-444-8318
Mailing Address - Fax:
Practice Address - Street 1:17512 SHADY RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6236
Practice Address - Country:US
Practice Address - Phone:302-444-8318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014884225100000X
MD21011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist