Provider Demographics
NPI:1265007926
Name:KELLY, JENNIFER LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:KELLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 US HWY 340N
Mailing Address - Street 2:
Mailing Address - City:RILEYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22650-2138
Mailing Address - Country:US
Mailing Address - Phone:540-742-5505
Mailing Address - Fax:
Practice Address - Street 1:198 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1015
Practice Address - Country:US
Practice Address - Phone:540-743-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist