Provider Demographics
NPI:1336491059
Name:DANA, KELLY P (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:P
Last Name:DANA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8300 CONSTITUTION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7613
Mailing Address - Country:US
Mailing Address - Phone:505-291-2967
Mailing Address - Fax:505-291-2504
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-291-2967
Practice Address - Fax:505-291-2504
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM4174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist