Provider Demographics
NPI:1255227534
Name:KELLY, ROBERT VICTOR III (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:VICTOR
Last Name:KELLY
Suffix:III
Gender:M
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 1:409 S LENZNER AVE APT 9201
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5647
Mailing Address - Country:US
Mailing Address - Phone:702-556-4140
Mailing Address - Fax:
Practice Address - Street 1:2520 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2843
Practice Address - Country:US
Practice Address - Phone:520-685-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-14
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-034209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist