Provider Demographics
NPI:1790904894
Name:TOLER, KELLY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:TOLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 ROUTE 3A
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4007
Mailing Address - Country:US
Mailing Address - Phone:603-491-1109
Mailing Address - Fax:
Practice Address - Street 1:783 ROUTE 3A
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304
Practice Address - Country:US
Practice Address - Phone:603-491-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist