Provider Demographics
NPI:1164855565
Name:MURRAY, KELLY E (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:8 BRETTON RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1208
Mailing Address - Country:US
Mailing Address - Phone:518-522-1151
Mailing Address - Fax:
Practice Address - Street 1:145 HAZARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4521
Practice Address - Country:US
Practice Address - Phone:860-265-2571
Practice Address - Fax:860-265-2574
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT9906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9906OtherSTATE OF CT PHYSICAL THERAPY LICENSE