Provider Demographics
NPI:1568097798
Name:MAXWELL, KELLY (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:DEANGELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:470 JOHN YOUNG WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2557
Mailing Address - Country:US
Mailing Address - Phone:610-873-3076
Mailing Address - Fax:610-873-3078
Practice Address - Street 1:470 JOHN YOUNG WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2557
Practice Address - Country:US
Practice Address - Phone:610-873-3076
Practice Address - Fax:610-873-3078
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist