Provider Demographics
NPI:1942823133
Name:HALBERT, KELLI (PT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HALBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5608 MOUNTAIN ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1909
Mailing Address - Country:US
Mailing Address - Phone:903-217-3504
Mailing Address - Fax:
Practice Address - Street 1:5608 MOUNTAIN ISLAND DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-1909
Practice Address - Country:US
Practice Address - Phone:903-217-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1330572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist