Provider Demographics
NPI:1114142718
Name:BRONZINI, KELLY ANN (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BRONZINI
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 1:163 CHESTNUT TER
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2410
Mailing Address - Country:US
Mailing Address - Phone:973-983-6007
Mailing Address - Fax:
Practice Address - Street 1:84 COLD HILL RD
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-2021
Practice Address - Country:US
Practice Address - Phone:973-543-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00940200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist