Provider Demographics
NPI:1336171974
Name:KELLEY, REID THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:REID
Middle Name:THOMAS
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 UPPER HEMBREE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4651
Mailing Address - Country:US
Mailing Address - Phone:678-667-3435
Mailing Address - Fax:404-201-2080
Practice Address - Street 1:1250 UPPER HEMBREE RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4651
Practice Address - Country:US
Practice Address - Phone:404-358-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009889225100000X, 2251S0007X
OKPT 3754225100000X
SC59752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic