Provider Demographics
NPI:1598933541
Name:KIELY, JACQUELINE NILLASCA (DPT, MSPT)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:NILLASCA
Last Name:KIELY
Suffix:
Gender:F
Credentials:DPT, MSPT
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:MICHELLE
Other - Last Name:NILLASCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, MSPT
Mailing Address - Street 1:725 WELCH ROAD
Mailing Address - Street 2:SUITE 388
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-497-8218
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD FL 3
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323252251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics