Provider Demographics
NPI:1477752574
Name:KELLEY, KIM PERKINS (PT, MED)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:PERKINS
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1209
Mailing Address - Country:US
Mailing Address - Phone:802-388-1153
Mailing Address - Fax:802-388-1153
Practice Address - Street 1:40 HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1209
Practice Address - Country:US
Practice Address - Phone:802-388-1153
Practice Address - Fax:802-388-1153
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-00020432251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT19824OtherBLUE CROSS AND BLUE SHIEL
VT43V600OtherMVP