Provider Demographics
NPI:1003061433
Name:KELLY-KINNEY, BARBARA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:KELLY-KINNEY
Suffix:
Gender:F
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:ROSE
Mailing Address - State:NY
Mailing Address - Zip Code:14542-0039
Mailing Address - Country:US
Mailing Address - Phone:315-587-2069
Mailing Address - Fax:
Practice Address - Street 1:270 LAKE ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1832
Practice Address - Country:US
Practice Address - Phone:315-536-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007700-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist