Provider Demographics
NPI:1801002555
Name:CANNEY, KELLY KEVILLE (PT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KEVILLE
Last Name:CANNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:KEVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2612
Mailing Address - Country:US
Mailing Address - Phone:774-270-0813
Mailing Address - Fax:
Practice Address - Street 1:3 BURLINGTON WOODS
Practice Address - Street 2:SUITE 304
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4514
Practice Address - Country:US
Practice Address - Phone:781-270-0222
Practice Address - Fax:781-270-5005
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist