Provider Demographics
NPI:1205142114
Name:CAVE, KELLY CH (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CH
Last Name:CAVE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 RIVER LANDING DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5000
Mailing Address - Country:US
Mailing Address - Phone:770-640-6056
Mailing Address - Fax:
Practice Address - Street 1:195 RIVER LANDING DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5000
Practice Address - Country:US
Practice Address - Phone:770-640-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist