Provider Demographics
NPI:1437403425
Name:FLETCHER, KELLY (MSPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 E PARHAM RD
Mailing Address - Street 2:MOB II SUITE 120
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4373
Mailing Address - Country:US
Mailing Address - Phone:804-545-4952
Mailing Address - Fax:804-545-4953
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:MOB II SUITE 120
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-545-4952
Practice Address - Fax:804-545-4953
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist