Provider Demographics
NPI:1376919191
Name:FECH, KELLY J (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:FECH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 PORTICO DR APT 1126
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4173
Mailing Address - Country:US
Mailing Address - Phone:575-649-4359
Mailing Address - Fax:
Practice Address - Street 1:220 N RIDGEWAY DR STE A
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4148
Practice Address - Country:US
Practice Address - Phone:817-774-5002
Practice Address - Fax:817-774-5034
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist