Provider Demographics
NPI:1881060564
Name:KELLY, PATRICK GUENETTE (DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:GUENETTE
Last Name:KELLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HESTERS CROSSING RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6946
Mailing Address - Country:US
Mailing Address - Phone:512-310-1928
Mailing Address - Fax:512-310-9180
Practice Address - Street 1:301 HESTERS CROSSING RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6946
Practice Address - Country:US
Practice Address - Phone:512-310-1928
Practice Address - Fax:512-310-9180
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12648922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1264892Other1264892