Provider Demographics
NPI:1033307590
Name:FLEMING, KELLY ANNE (PT, DPT, PCS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:TOELKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PCS
Mailing Address - Street 1:26 KNOLLTOP DR
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2222
Mailing Address - Country:US
Mailing Address - Phone:631-382-3922
Mailing Address - Fax:
Practice Address - Street 1:3279 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7673
Practice Address - Country:US
Practice Address - Phone:631-580-8720
Practice Address - Fax:631-580-8727
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist