Provider Demographics
NPI:1346240025
Name:KELLY, LAUREN MICHELE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MICHELE
Other - Last Name:GOTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1100 GROSSER RD
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9224
Mailing Address - Country:US
Mailing Address - Phone:610-369-0030
Mailing Address - Fax:
Practice Address - Street 1:1100 GROSSER RD
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9224
Practice Address - Country:US
Practice Address - Phone:610-369-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
089685QYQMedicare ID - Type Unspecified