Provider Demographics
NPI:1104208180
Name:MILLER, KELLY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:OSTERRIEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2284 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4685
Mailing Address - Country:US
Mailing Address - Phone:724-788-1770
Mailing Address - Fax:724-788-1994
Practice Address - Street 1:2284 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4685
Practice Address - Country:US
Practice Address - Phone:724-788-1770
Practice Address - Fax:724-788-1994
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist