Provider Demographics
NPI:1265816441
Name:KELLY, AARON (PT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 HIGHWAY 179
Mailing Address - Street 2:STE. 118
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-7985
Mailing Address - Country:US
Mailing Address - Phone:928-282-8428
Mailing Address - Fax:
Practice Address - Street 1:6560 HIGHWAY 179
Practice Address - Street 2:STE. 118
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7985
Practice Address - Country:US
Practice Address - Phone:928-282-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic