Provider Demographics
NPI:1326056961
Name:HIX, KELLY A (PT, MPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:HIX
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N ROCKTON AVE
Mailing Address - Street 2:PHYSICAL THERAPY
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3619
Mailing Address - Country:US
Mailing Address - Phone:815-971-2000
Mailing Address - Fax:815-971-9162
Practice Address - Street 1:2300 N ROCKTON AVE
Practice Address - Street 2:PHYSICAL THERAPY
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3619
Practice Address - Country:US
Practice Address - Phone:815-971-2000
Practice Address - Fax:815-971-9162
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-012044OtherSTATE LICENSE
IL070-012044OtherSTATE LICENSE