Provider Demographics
NPI:1962673707
Name:DOLPHIN, KELLY JAE (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JAE
Last Name:DOLPHIN
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 1:1855 POWDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-848-4800
Mailing Address - Fax:717-741-4759
Practice Address - Street 1:1855 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4723
Practice Address - Country:US
Practice Address - Phone:717-848-4800
Practice Address - Fax:717-741-4759
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019641225100000X
MD22481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18444OtherHEALTH AMERICA
PA03182100OtherCAPITAL BLUE CROSS
PA0068377000OtherAMERIHEALTH UNDER IBC
PA332313OtherHIGHMARK BLUE SHIELD
PA177124OtherMEDICARE HGS ADMINISTRATORS
PACK4276OtherPALMETTO GBA RR MEDICARE
PA18444OtherHEALTH AMERICA
PA0197900001Medicare NSC