Provider Demographics
NPI:1326185570
Name:KELLY, CHRISTA ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:ELLEN
Last Name:KELLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5430
Mailing Address - Country:US
Mailing Address - Phone:319-277-6960
Mailing Address - Fax:
Practice Address - Street 1:3706 CEDAR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6207
Practice Address - Country:US
Practice Address - Phone:319-273-8250
Practice Address - Fax:319-273-8275
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008982251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics