Provider Demographics
NPI:1750337127
Name:KELLY, EILEEN (PT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8566
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-0566
Mailing Address - Country:US
Mailing Address - Phone:856-663-7080
Mailing Address - Fax:856-663-4945
Practice Address - Street 1:1871 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2020
Practice Address - Country:US
Practice Address - Phone:856-424-4240
Practice Address - Fax:856-424-3824
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA007520002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQA07520OtherSTATE LICENSE NUMBER