Provider Demographics
NPI:1811083595
Name:KELLY, JOSEPH M (MSPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:KELLY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332
Mailing Address - Country:US
Mailing Address - Phone:781-740-2289
Mailing Address - Fax:
Practice Address - Street 1:2 KEITH WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-740-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3776947OtherAETNA
MA64-00321OtherUNITED HEALTHCARE
MAY66770OtherBLUE CROSS BLUE SHIELD
MA44996OtherFALLON HEALTH INS.
MA455246OtherTUFTS HEALTH PLAN
MA918633OtherFIRST HEALTH
MA0365572Medicaid
MA37250OtherHARVARD PILGRIM INS
MAY68039Medicare ID - Type Unspecified