Provider Demographics
NPI:1760536270
Name:BARRY, KELLY SMITH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SMITH
Last Name:BARRY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:115 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2615
Mailing Address - Country:US
Mailing Address - Phone:916-355-8500
Mailing Address - Fax:
Practice Address - Street 1:115 NATOMA ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2615
Practice Address - Country:US
Practice Address - Phone:916-355-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist