Provider Demographics
NPI:1487816070
Name:THOMAS, KELLIE JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:JEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROCKING CHAIR LN
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2428
Mailing Address - Country:US
Mailing Address - Phone:603-362-9672
Mailing Address - Fax:
Practice Address - Street 1:172 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-3849
Practice Address - Country:US
Practice Address - Phone:978-685-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2642225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant