Provider Demographics
NPI:1477763647
Name:REMUS, KELLY FLORENCE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:FLORENCE
Last Name:REMUS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 GALLAHER ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3507
Mailing Address - Country:US
Mailing Address - Phone:304-634-9997
Mailing Address - Fax:
Practice Address - Street 1:337 4TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1223
Practice Address - Country:US
Practice Address - Phone:304-634-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist