Provider Demographics
NPI:1982487559
Name:HARWOOD, KELLY HELMS (PTA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HELMS
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 AUDUBON BLVD STE B4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6753
Mailing Address - Country:US
Mailing Address - Phone:910-392-2240
Mailing Address - Fax:910-392-2242
Practice Address - Street 1:1409 AUDUBON BLVD STE B4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6753
Practice Address - Country:US
Practice Address - Phone:910-392-2240
Practice Address - Fax:910-392-2242
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant