Provider Demographics
NPI:1679740500
Name:DULLAGHAN, KELLIE ANN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANN
Last Name:DULLAGHAN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 COLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5836
Mailing Address - Country:US
Mailing Address - Phone:919-460-6500
Mailing Address - Fax:919-460-0206
Practice Address - Street 1:711 COLLINGTON DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5836
Practice Address - Country:US
Practice Address - Phone:919-460-6500
Practice Address - Fax:919-460-0206
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3917225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant