Provider Demographics
NPI:1285627927
Name:PINTI, KELLY L (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:PINTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:KLAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:435 BUCKHANNON PIKE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4307
Mailing Address - Country:US
Mailing Address - Phone:304-622-1600
Mailing Address - Fax:304-622-4747
Practice Address - Street 1:435 BUCKHANNON PIKE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4307
Practice Address - Country:US
Practice Address - Phone:304-622-1600
Practice Address - Fax:304-622-4747
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7304115000Medicaid
WV7304115000Medicaid