Provider Demographics
NPI:1538464144
Name:LAND, KELLY (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 AIRPORT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5931
Mailing Address - Country:US
Mailing Address - Phone:850-477-6966
Mailing Address - Fax:850-477-0267
Practice Address - Street 1:2065 AIRPORT BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5931
Practice Address - Country:US
Practice Address - Phone:850-477-6966
Practice Address - Fax:850-477-0267
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3685225100000X
FLPT29776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist