Provider Demographics
NPI:1265844930
Name:KELLY, COLIN MICHAEL (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:MICHAEL
Last Name:KELLY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140B PEACH LN
Mailing Address - Street 2:
Mailing Address - City:WEST LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-1506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140B PEACH LN
Practice Address - Street 2:
Practice Address - City:WEST LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-1506
Practice Address - Country:US
Practice Address - Phone:412-760-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer