Provider Demographics
NPI:1780777987
Name:TRIPI, KELLY MICHELLE (DPT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MICHELLE
Last Name:TRIPI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1009
Mailing Address - Country:US
Mailing Address - Phone:201-638-0250
Mailing Address - Fax:
Practice Address - Street 1:601 HAMBURG TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2048
Practice Address - Country:US
Practice Address - Phone:973-341-3991
Practice Address - Fax:973-942-6339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA001002500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist