Provider Demographics
NPI:1700310752
Name:POLIZZI, KELLI (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CUMBERLAND SQ
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3408
Mailing Address - Country:US
Mailing Address - Phone:615-547-1229
Mailing Address - Fax:
Practice Address - Street 1:1 CUMBERLAND SQ
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3408
Practice Address - Country:US
Practice Address - Phone:615-547-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer