Provider Demographics
NPI:1295391241
Name:PEREZ CREANE, KELLY (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:PEREZ CREANE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-294-6734
Practice Address - Street 1:888 WHITE PLAINS RD STE 209
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4552
Practice Address - Country:US
Practice Address - Phone:203-459-1133
Practice Address - Fax:203-466-8527
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist