Provider Demographics
NPI:1376033167
Name:MUELLER, KELLY COLETTE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:COLETTE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W MLK BLVD
Mailing Address - Street 2:SUITE 708
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402
Mailing Address - Country:US
Mailing Address - Phone:423-362-4381
Mailing Address - Fax:866-591-0619
Practice Address - Street 1:100 W MLK BLVD
Practice Address - Street 2:SUITE 708
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402
Practice Address - Country:US
Practice Address - Phone:423-822-8824
Practice Address - Fax:866-591-0619
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN130892251X0800X, 225100000X
WI14161-242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist