Provider Demographics
NPI:1073873543
Name:BALL, KELLY E (PT,DPT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:E
Last Name:BALL
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:E
Other - Last Name:COUGHLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:70 BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3974
Mailing Address - Country:US
Mailing Address - Phone:603-893-2900
Mailing Address - Fax:603-893-1628
Practice Address - Street 1:70 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3974
Practice Address - Country:US
Practice Address - Phone:603-893-2900
Practice Address - Fax:603-893-1628
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist