Provider Demographics
NPI:1972772739
Name:HALSEY, KELLY JONES (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JONES
Last Name:HALSEY
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 1:457 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7776
Mailing Address - Country:US
Mailing Address - Phone:732-840-7500
Mailing Address - Fax:732-840-2088
Practice Address - Street 1:457 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7776
Practice Address - Country:US
Practice Address - Phone:732-840-7500
Practice Address - Fax:732-840-2088
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA016486002251X0800X, 2251X0800X
VA2305205352225100000X
CA412832251X0800X
OR67272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJR171407Medicare PIN
CAW17215AMedicare PIN
CACB233056Medicare PIN
CAW17215Medicare PIN
CAR171407Medicare PIN
VAP00480707OtherRAILROAD MEDICARE
VA016900T54Medicare PIN
CAR171407Medicare PIN