Provider Demographics
NPI:1013964956
Name:KELLEY, DENISE MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MICHELLE
Other - Last Name:HARTSHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:CEDAR RIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95924-0010
Mailing Address - Country:US
Mailing Address - Phone:530-277-2160
Mailing Address - Fax:
Practice Address - Street 1:569 SEARLS AVE
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3063
Practice Address - Country:US
Practice Address - Phone:530-478-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist