Provider Demographics
NPI:1609604867
Name:KELLY, MONET JEAN (DPT)
Entity type:Individual
Prefix:
First Name:MONET
Middle Name:JEAN
Last Name:KELLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HOSPITAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6113
Mailing Address - Country:US
Mailing Address - Phone:410-760-2162
Mailing Address - Fax:410-760-2975
Practice Address - Street 1:308 HOSPITAL DR STE 105
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6113
Practice Address - Country:US
Practice Address - Phone:410-760-2162
Practice Address - Fax:410-760-2975
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist