Provider Demographics
NPI:1770975203
Name:SCALSKY, KELLY RENEE (PTA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:RENEE
Last Name:SCALSKY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:351 STATE HIGHWAY 121 BYP
Mailing Address - Street 2:APT 2415
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4187
Mailing Address - Country:US
Mailing Address - Phone:814-880-8809
Mailing Address - Fax:
Practice Address - Street 1:8267 ELMBROOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4030
Practice Address - Country:US
Practice Address - Phone:214-350-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2109335225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant