Provider Demographics
NPI:1699806273
Name:ORMAN, KELLY REID (PT,MTC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:REID
Last Name:ORMAN
Suffix:
Gender:M
Credentials:PT,MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SEMINARY
Mailing Address - State:MS
Mailing Address - Zip Code:39479-9027
Mailing Address - Country:US
Mailing Address - Phone:601-722-2222
Mailing Address - Fax:601-822-0150
Practice Address - Street 1:1074 HIGHWAY 13 N STE 210
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-8568
Practice Address - Country:US
Practice Address - Phone:601-722-2222
Practice Address - Fax:601-822-0150
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist