Provider Demographics
NPI:1922083716
Name:CARR, KELLEY LAYNE (DPT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:LAYNE
Last Name:CARR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MACGHEE ROAD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603
Mailing Address - Country:US
Mailing Address - Phone:845-702-7693
Mailing Address - Fax:
Practice Address - Street 1:301 MANCHESTER ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603
Practice Address - Country:US
Practice Address - Phone:845-454-4137
Practice Address - Fax:845-454-6457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025316 1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10097129OtherCDPHP
Q05T71Medicare ID - Type Unspecified