Provider Demographics
NPI:1063710424
Name:RAMIREZ, KELLY KRISTINE (MPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KRISTINE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KRISTINE
Other - Last Name:DEALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2145 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1141
Mailing Address - Country:US
Mailing Address - Phone:408-248-6886
Mailing Address - Fax:408-248-4923
Practice Address - Street 1:2145 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1141
Practice Address - Country:US
Practice Address - Phone:408-248-6886
Practice Address - Fax:408-248-4923
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist