Provider Demographics
NPI:1568706679
Name:STONE, KELLIE MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:MARIE
Last Name:STONE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 LEBANON ROAD
Mailing Address - Street 2:
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122
Mailing Address - Country:US
Mailing Address - Phone:615-288-7912
Mailing Address - Fax:615-288-7913
Practice Address - Street 1:11060 LEBANON ROAD
Practice Address - Street 2:
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-288-7912
Practice Address - Fax:615-288-7913
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2764225100000X
TN14677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist