Provider Demographics
NPI:1114230521
Name:FOX, KELLY A (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:FOX
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 GUEST CALL
Mailing Address - Street 2:UNIT 346
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6595
Mailing Address - Country:US
Mailing Address - Phone:410-562-3476
Mailing Address - Fax:
Practice Address - Street 1:6820 GUEST CALL
Practice Address - Street 2:UNIT 346
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6595
Practice Address - Country:US
Practice Address - Phone:410-562-3476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052065392251P0200X
MD232942251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23294OtherMARYLAND STATE BOARD OF PHYSICAL THERAPY
VA2305206539OtherVIRGINIA BOARD OF PHYSICAL THERAPY