Provider Demographics
NPI:1114969961
Name:KELLY, RICHARD LANCE (MPT,ATC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LANCE
Last Name:KELLY
Suffix:
Gender:M
Credentials:MPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15945 PAYNES FARM DR
Mailing Address - Street 2:RICHARD.L.KELLY@MEDSTAR.NET
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3406
Mailing Address - Country:US
Mailing Address - Phone:706-593-7719
Mailing Address - Fax:
Practice Address - Street 1:1120 20TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-416-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA6446225100000X
DC8718292081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist