Provider Demographics
NPI:1558547521
Name:MCKELVEY, MARSHA LOU (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LOU
Last Name:MCKELVEY
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 1:3030B NW 79TH CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6270
Mailing Address - Country:US
Mailing Address - Phone:352-374-8020
Mailing Address - Fax:
Practice Address - Street 1:2622 NW 43RD ST STE C3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6679
Practice Address - Country:US
Practice Address - Phone:352-374-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA7026172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist