Provider Demographics
NPI:1013296565
Name:SWENSON HALL, KELLY ELISABETH (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ELISABETH
Last Name:SWENSON HALL
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 1:3915 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1701
Mailing Address - Country:US
Mailing Address - Phone:941-747-7741
Mailing Address - Fax:941-747-1431
Practice Address - Street 1:3915 8TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1701
Practice Address - Country:US
Practice Address - Phone:941-747-7741
Practice Address - Fax:941-747-1431
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist