Provider Demographics
NPI:1881862100
Name:CLEVELAND, KELLY MARIE (PT ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:GILMANTON IRON WORKS
Mailing Address - State:NH
Mailing Address - Zip Code:03837-4500
Mailing Address - Country:US
Mailing Address - Phone:603-267-6347
Mailing Address - Fax:
Practice Address - Street 1:175 BLUEBERRY LN
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2918
Practice Address - Country:US
Practice Address - Phone:603-524-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0232225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant