Provider Demographics
NPI:1831536242
Name:FLEMMING, KELLY ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:FLEMMING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:BIEDERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 SAINT PAUL ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1334
Mailing Address - Country:US
Mailing Address - Phone:301-432-8585
Mailing Address - Fax:301-432-1987
Practice Address - Street 1:9 SAINT PAUL ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1334
Practice Address - Country:US
Practice Address - Phone:301-432-8585
Practice Address - Fax:301-432-1987
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3921225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant