Provider Demographics
NPI:1740573302
Name:KELLY, JENNIFER DALECKI (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DALECKI
Last Name:KELLY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 CEDAR BERRY LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7210
Mailing Address - Country:US
Mailing Address - Phone:919-259-7000
Mailing Address - Fax:
Practice Address - Street 1:523 CEDAR BERRY LN
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7210
Practice Address - Country:US
Practice Address - Phone:919-259-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1203058225100000X
NCP14191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist