Provider Demographics
NPI:1447675129
Name:KELLEY, KEVIN D (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEUMANN WAY
Mailing Address - Street 2:BLDG. 750
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1915
Mailing Address - Country:US
Mailing Address - Phone:513-853-8900
Mailing Address - Fax:513-853-8998
Practice Address - Street 1:1 NEUMANN WAY
Practice Address - Street 2:BLDG. 750
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1915
Practice Address - Country:US
Practice Address - Phone:513-853-8900
Practice Address - Fax:513-853-8998
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-006393225100000X
OHPT-014669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist