Provider Demographics
NPI:1609820471
Name:FERRIS, KELLY JAY (PT)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:JAY
Last Name:FERRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CAMPBELL WAY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-6615
Mailing Address - Country:US
Mailing Address - Phone:865-573-5557
Mailing Address - Fax:865-522-3218
Practice Address - Street 1:1015 CAMPBELL WAY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-6615
Practice Address - Country:US
Practice Address - Phone:865-573-5557
Practice Address - Fax:865-522-3218
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3651332Medicaid
TN3651332OtherMEDICARE ID-TYPE UNSPECIFIED PHYSICAL THERAPY
TN3651552OtherMEDICARE ID-TYPE UNSPECIFIED PHYSICAL THERAPY GROUP
TN3105588OtherBCBS PHYSICAL THERAPY
TN650016650OtherMEDICARE RAILROAD