Provider Demographics
NPI:1194848671
Name:KELLY, ERIN ANNE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FULMORE AVE
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3428
Mailing Address - Country:US
Mailing Address - Phone:215-620-6203
Mailing Address - Fax:
Practice Address - Street 1:1104 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3730
Practice Address - Country:US
Practice Address - Phone:215-676-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist