Provider Demographics
NPI:1407948391
Name:KELLY, BEVERLY S (PHYSCIAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:S
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHYSCIAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 ABERCORN ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5713
Mailing Address - Country:US
Mailing Address - Phone:912-354-4474
Mailing Address - Fax:912-354-4443
Practice Address - Street 1:6555 ABERCORN ST
Practice Address - Street 2:SUITE 221
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5713
Practice Address - Country:US
Practice Address - Phone:912-354-4474
Practice Address - Fax:912-354-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist