Provider Demographics
NPI:1770959298
Name:DIAS, KELLY LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:DIAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:LAPEUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-7800
Mailing Address - Fax:704-824-2822
Practice Address - Street 1:1428 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3902
Practice Address - Country:US
Practice Address - Phone:704-748-0516
Practice Address - Fax:980-389-0044
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist