Provider Demographics
NPI:1831690940
Name:KELLY, SAMUEL (DPT)
Entity type:Individual
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First Name:SAMUEL
Middle Name:
Last Name:KELLY
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:120 W GERMANTOWN PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1420
Mailing Address - Country:US
Mailing Address - Phone:610-270-0370
Mailing Address - Fax:610-270-0374
Practice Address - Street 1:1411 WOODBOURNE RD STE B
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1540
Practice Address - Country:US
Practice Address - Phone:267-630-5740
Practice Address - Fax:267-630-5741
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic