Provider Demographics
NPI:1396035432
Name:PEARSON, KELLEY MEEHAN (PT, PCS)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:MEEHAN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10 SUNDANCE CT
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5203
Mailing Address - Country:US
Mailing Address - Phone:817-807-8898
Mailing Address - Fax:817-488-8834
Practice Address - Street 1:10 SUNDANCE CT
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5203
Practice Address - Country:US
Practice Address - Phone:817-488-8833
Practice Address - Fax:817-488-8834
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11604532081P0010X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine