Provider Demographics
NPI:1295346419
Name:KELLY, DYLAN L (DPT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:L
Last Name:KELLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4572 TELEPHONE RD STE 903
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5663
Mailing Address - Country:US
Mailing Address - Phone:805-654-8127
Mailing Address - Fax:805-654-8149
Practice Address - Street 1:4572 TELEPHONE RD STE 903
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5663
Practice Address - Country:US
Practice Address - Phone:805-654-8127
Practice Address - Fax:805-654-8149
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA2987442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA298744OtherSTATE LICENSE