Provider Demographics
NPI:1467652594
Name:HUTTO, KELLEY HACKLER (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:HACKLER
Last Name:HUTTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6347 PICKNEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1590
Mailing Address - Country:US
Mailing Address - Phone:850-668-1857
Mailing Address - Fax:850-668-1857
Practice Address - Street 1:6347 PICKNEY HILL RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1590
Practice Address - Country:US
Practice Address - Phone:850-668-1857
Practice Address - Fax:850-668-1857
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT133492251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics