Provider Demographics
NPI:1508879784
Name:KOURI, KELLIE MICHELLE (MPT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:MICHELLE
Last Name:KOURI
Suffix:
Gender:
Credentials:MPT
Other - Prefix:MRS
Other - First Name:KELLIE
Other - Middle Name:KOURI
Other - Last Name:BARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 715868
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5868
Mailing Address - Country:US
Mailing Address - Phone:804-915-1910
Mailing Address - Fax:804-968-1803
Practice Address - Street 1:15300 E WEST RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3372
Practice Address - Country:US
Practice Address - Phone:804-320-4064
Practice Address - Fax:804-320-4052
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist