Provider Demographics
NPI:1447211826
Name:BIGELOW, KELLY MYOTT (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MYOTT
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MYOTT
Other - Last Name:MARCHETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:410-571-2946
Mailing Address - Fax:
Practice Address - Street 1:127 LUBRANO DR STE 100
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7559
Practice Address - Country:US
Practice Address - Phone:410-224-0144
Practice Address - Fax:410-224-0143
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist