Provider Demographics
NPI:1285213066
Name:KELLY, ANNE C
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 POINTE CENTER CT STE 110
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2670
Mailing Address - Country:US
Mailing Address - Phone:703-523-1790
Mailing Address - Fax:
Practice Address - Street 1:3600 POINTE CENTER CT STE 110
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2670
Practice Address - Country:US
Practice Address - Phone:703-523-1790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211114225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist