Provider Demographics
NPI:1659348035
Name:KELLY, ANNE GERISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:GERISE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:GERISE
Other - Last Name:HEITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8 GRENLOCH DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08560-1114
Mailing Address - Country:US
Mailing Address - Phone:609-466-2071
Mailing Address - Fax:
Practice Address - Street 1:90 WEST AFTON AVE
Practice Address - Street 2:SUITE G 5 AND 6
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-493-2666
Practice Address - Fax:215-493-6639
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001682843OtherHIGHMARK BLUESHIELD
PA2356289000OtherIBC
PA1011197760001Medicaid