Provider Demographics
NPI:1144620816
Name:BARBERIAN, KELLY (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:BARBERIAN
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 1:9155 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-4127
Mailing Address - Country:US
Mailing Address - Phone:804-305-5569
Mailing Address - Fax:804-559-8946
Practice Address - Street 1:7090 COVENANT WOODS DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-7025
Practice Address - Country:US
Practice Address - Phone:804-559-8936
Practice Address - Fax:804-559-8946
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist