Provider Demographics
NPI:1669705620
Name:HAVENS, KELLEY YOUNG (PT)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:YOUNG
Last Name:HAVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:JO
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7145 N. CHESTNUT AVE.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-999-6147
Mailing Address - Fax:559-323-9157
Practice Address - Street 1:CORNERSTONE PHYSICAL THERAPY
Practice Address - Street 2:7145 N. CHESTNUT AVE. SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-299-2244
Practice Address - Fax:559-299-2487
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist