Provider Demographics
NPI:1710213814
Name:KELLEY, MICHELE RENEE (MPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:RENEE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:HELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:2850 COMMERCE DR STE 200B
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9383
Practice Address - Country:US
Practice Address - Phone:717-692-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT002121225100000X
PAPT013529L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032938300008Medicaid
PA808709OtherMEDICARE