Provider Demographics
NPI:1194146746
Name:KELLEY, CHRISTINA DANIELLE (LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DANIELLE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 IRISH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-5738
Mailing Address - Country:US
Mailing Address - Phone:817-903-6878
Mailing Address - Fax:
Practice Address - Street 1:7912 IRISH DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5738
Practice Address - Country:US
Practice Address - Phone:817-903-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-29
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21652255A2300X
TXAT52702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer