Provider Demographics
NPI:1710221015
Name:BOONE, KELLY J (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:BOONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:403 N MILES ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1834
Mailing Address - Country:US
Mailing Address - Phone:270-360-9129
Mailing Address - Fax:270-234-8197
Practice Address - Street 1:4331 CHURCHMAN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1164
Practice Address - Country:US
Practice Address - Phone:502-366-1773
Practice Address - Fax:502-366-3500
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY002362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist