Provider Demographics
NPI:1770140360
Name:PATE, KELLY C (LPTA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:C
Last Name:PATE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-4326
Mailing Address - Country:US
Mailing Address - Phone:256-738-0468
Mailing Address - Fax:
Practice Address - Street 1:12000 TURNMEYER DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-3358
Practice Address - Country:US
Practice Address - Phone:256-881-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4136225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant