Provider Demographics
NPI:1366850372
Name:PAGNOTTA, KELLY D (PHD, ATC, PES)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:PAGNOTTA
Suffix:
Gender:F
Credentials:PHD, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEUMANN DR
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1277
Mailing Address - Country:US
Mailing Address - Phone:610-358-4551
Mailing Address - Fax:
Practice Address - Street 1:1 NEUMANN DR
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-1277
Practice Address - Country:US
Practice Address - Phone:610-358-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0005202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer