Provider Demographics
NPI:1902207038
Name:KELLY, KRISTY MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:MARIE
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9027 PLANTERS XING
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9618
Mailing Address - Country:US
Mailing Address - Phone:757-561-5536
Mailing Address - Fax:
Practice Address - Street 1:1811 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2326
Practice Address - Country:US
Practice Address - Phone:757-229-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist