Provider Demographics
NPI:1962493080
Name:KELLEY, CHERYL L (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1134
Mailing Address - Country:US
Mailing Address - Phone:540-484-1456
Mailing Address - Fax:540-484-1236
Practice Address - Street 1:300 PELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1134
Practice Address - Country:US
Practice Address - Phone:540-484-1456
Practice Address - Fax:540-484-1236
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist