Provider Demographics
NPI:1083605844
Name:KELLEY, BETSY (PT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:KELLEY
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 1:212 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2337
Mailing Address - Country:US
Mailing Address - Phone:859-625-0001
Mailing Address - Fax:859-625-1109
Practice Address - Street 1:212 WAYNE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2337
Practice Address - Country:US
Practice Address - Phone:859-625-0001
Practice Address - Fax:859-625-1109
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000199366OtherBC FOR PARIS
KY000000344016OtherBC FOR HARRISON
KY000000344016OtherBC FOR HARRISON
KY5026301Medicare ID - Type UnspecifiedFOR PARIS