Provider Demographics
NPI:1750460028
Name:ROE, DESNE KELL (PT, CLT)
Entity Type:Individual
Prefix:
First Name:DESNE
Middle Name:KELL
Last Name:ROE
Suffix:
Gender:F
Credentials:PT, CLT
Other - Prefix:
Other - First Name:DESNE
Other - Middle Name:LEE
Other - Last Name:KELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, CLT
Mailing Address - Street 1:28012 OAKLANDS CIR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8264
Mailing Address - Country:US
Mailing Address - Phone:410-822-4613
Mailing Address - Fax:410-822-6534
Practice Address - Street 1:132 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1013
Practice Address - Country:US
Practice Address - Phone:410-822-4613
Practice Address - Fax:410-822-6534
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20131225100000X
DEJ10001541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216538Medicare ID - Type Unspecified