Provider Demographics
NPI:1508653684
Name:KELLY, NOLAN (DPT)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:KELLY
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:NOLAN
Other - Middle Name:
Other - Last Name:LUNDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1693
Mailing Address - Country:US
Mailing Address - Phone:207-363-0888
Mailing Address - Fax:
Practice Address - Street 1:8 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1693
Practice Address - Country:US
Practice Address - Phone:207-363-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26102225100000X
ME7075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist