Provider Demographics
NPI:1619450111
Name:STUEBER, KELLY (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STUEBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:76 W JIMMIE LEEDS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9400
Mailing Address - Country:US
Mailing Address - Phone:609-748-5193
Mailing Address - Fax:097-485-1976
Practice Address - Street 1:76 W JIMMIE LEEDS RD STE 401
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9400
Practice Address - Country:US
Practice Address - Phone:609-748-5193
Practice Address - Fax:856-748-5197
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01814400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist