Provider Demographics
NPI:1164555793
Name:SYKES, KELLY D (PT)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:D
Last Name:SYKES
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:8865 STANFORD BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5420
Mailing Address - Country:US
Mailing Address - Phone:410-290-4480
Mailing Address - Fax:410-290-4488
Practice Address - Street 1:8865 STANFORD BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5420
Practice Address - Country:US
Practice Address - Phone:410-290-4480
Practice Address - Fax:410-290-4488
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD18546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00291S35Medicare PIN