Provider Demographics
NPI:1003687229
Name:KELLY, ERIN PATRICIA (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:PATRICIA
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 1:9715 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1224
Mailing Address - Country:US
Mailing Address - Phone:201-637-8049
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290 STE F104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1042
Practice Address - Country:US
Practice Address - Phone:201-637-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13842012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic