Provider Demographics
NPI:1629694112
Name:KELLOGG, MARIAH A (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:A
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:A
Other - Last Name:CAIRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1324 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4117
Mailing Address - Country:US
Mailing Address - Phone:334-769-2003
Mailing Address - Fax:334-769-2004
Practice Address - Street 1:1324 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4117
Practice Address - Country:US
Practice Address - Phone:334-769-2003
Practice Address - Fax:334-769-2004
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH11653225100000X
AK162927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist