Provider Demographics
NPI:1598838005
Name:DENISE M KELLEY
Entity Type:Organization
Organization Name:DENISE M KELLEY
Other - Org Name:FIT FOR LIFE PHYISCAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNERPHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-470-9100
Mailing Address - Street 1:555 SEARLS AVE
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-3003
Mailing Address - Country:US
Mailing Address - Phone:530-470-9100
Mailing Address - Fax:530-470-9119
Practice Address - Street 1:555 SEARLS AVE
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3003
Practice Address - Country:US
Practice Address - Phone:530-470-9100
Practice Address - Fax:530-470-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty