Provider Demographics
NPI:1659896488
Name:HARVEY, KELLY JEAN (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4786 BRIAR CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-9510
Mailing Address - Country:US
Mailing Address - Phone:828-291-1855
Mailing Address - Fax:
Practice Address - Street 1:1154 LENOIR RHYNE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5168
Practice Address - Country:US
Practice Address - Phone:828-244-3077
Practice Address - Fax:866-433-2198
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist