Provider Demographics
NPI:1821297334
Name:KELLEY, CRYSTAL JOY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JOY
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:JOY
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 BURLINGTON WOODS
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4514
Mailing Address - Country:US
Mailing Address - Phone:781-270-0222
Mailing Address - Fax:781-270-5005
Practice Address - Street 1:3 BURLINGTON WOODS
Practice Address - Street 2:SUITE 304
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4514
Practice Address - Country:US
Practice Address - Phone:781-270-0222
Practice Address - Fax:781-270-5005
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist