Provider Demographics
NPI:1770656621
Name:KELLEY, JOHN B (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:2335 CHURCH ST
Mailing Address - Street 2:STE G
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:11424 SULLIVAN RD
Practice Address - Street 2:BLDG C STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818
Practice Address - Country:US
Practice Address - Phone:225-261-7021
Practice Address - Fax:225-262-7826
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-06-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1022578Medicaid
LA3A115C943OtherMEDICARE
LA$$$$$$$$$0OtherBCBS