Provider Demographics
NPI:1700497237
Name:KELLYROSE THOMAS PLLC
Entity type:Organization
Organization Name:KELLYROSE THOMAS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:850-812-0329
Mailing Address - Street 1:1067 W. US HWY 24
Mailing Address - Street 2:UNIT 140
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863
Mailing Address - Country:US
Mailing Address - Phone:919-685-7849
Mailing Address - Fax:
Practice Address - Street 1:400 WEST MIDLAND AVENUE
Practice Address - Street 2:SUITE 160B
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-286-9768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty