Provider Demographics
NPI:1235418278
Name:KELLING, MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KELLING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1165
Mailing Address - Country:US
Mailing Address - Phone:740-263-7997
Mailing Address - Fax:740-326-4743
Practice Address - Street 1:781 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1165
Practice Address - Country:US
Practice Address - Phone:740-263-7997
Practice Address - Fax:740-326-4743
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT - 013341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist