Provider Demographics
NPI:1083908271
Name:KELLEY, ASHLEY BARBARA (ASHLEY KELLEY, MSPT)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:BARBARA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:ASHLEY KELLEY, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PETERBOROUGH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4212
Mailing Address - Country:US
Mailing Address - Phone:203-430-3584
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist