Provider Demographics
NPI:1568449502
Name:SETTANNI, KELLY JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JEAN
Last Name:SETTANNI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:KEIBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2566 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1832
Mailing Address - Country:US
Mailing Address - Phone:516-785-1667
Mailing Address - Fax:516-785-1668
Practice Address - Street 1:2566 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1832
Practice Address - Country:US
Practice Address - Phone:516-785-1667
Practice Address - Fax:516-785-1668
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0240731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02351224Medicaid
NYQ10Q11Medicare PIN
NY02351224Medicaid