Provider Demographics
NPI:1851669196
Name:FORD, KELLY ANN (MSPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:FORD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TRIPP ST
Mailing Address - Street 2:
Mailing Address - City:WEST WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1523
Mailing Address - Country:US
Mailing Address - Phone:570-855-3346
Mailing Address - Fax:
Practice Address - Street 1:300 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1695
Practice Address - Country:US
Practice Address - Phone:570-693-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011371L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist