Provider Demographics
NPI:1578835930
Name:MCGINNIS, KELLY ANN (MSPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SOMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2638
Mailing Address - Country:US
Mailing Address - Phone:908-234-9668
Mailing Address - Fax:908-234-1343
Practice Address - Street 1:95 SOMERVILLE RD
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2638
Practice Address - Country:US
Practice Address - Phone:908-234-9668
Practice Address - Fax:908-234-1343
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00415200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist