Provider Demographics
NPI:1710442827
Name:MEYER, KELLY PUTMAN (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:PUTMAN
Last Name:MEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MICHELLE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6810 HIGHWAY 2311
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-4287
Mailing Address - Country:US
Mailing Address - Phone:850-814-4204
Mailing Address - Fax:
Practice Address - Street 1:2575 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4458
Practice Address - Country:US
Practice Address - Phone:850-872-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist