Provider Demographics
NPI:1700532454
Name:MOLLOY, KELLY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:POORBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1975 GLENN MITCHELL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-507-0015
Mailing Address - Fax:757-301-7486
Practice Address - Street 1:1975 GLENN MITCHELL DR STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-507-0015
Practice Address - Fax:757-301-7486
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist