Provider Demographics
NPI:1184956807
Name:PREITE, KELLY MARIE (MPT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:PREITE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N ELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2838
Mailing Address - Country:US
Mailing Address - Phone:714-595-7471
Mailing Address - Fax:626-335-3497
Practice Address - Street 1:416 N ELWOOD AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2838
Practice Address - Country:US
Practice Address - Phone:714-595-7471
Practice Address - Fax:626-335-3497
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 18866OtherPHYSICAL THERAPY BOARD OF CALIFORNIA