Provider Demographics
NPI:1821449596
Name:VANHOY, KELLY (LAT, ATC, LBMT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:VANHOY
Suffix:
Gender:F
Credentials:LAT, ATC, LBMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4947 BARRIER RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7933
Mailing Address - Country:US
Mailing Address - Phone:704-793-9756
Mailing Address - Fax:
Practice Address - Street 1:4947 BARRIER RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-7933
Practice Address - Country:US
Practice Address - Phone:704-793-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02732255A2300X
NC1007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer