Provider Demographics
NPI:1194325571
Name:POWLES, KELLY R (DPT, PT, CMTPT)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:POWLES
Suffix:
Gender:F
Credentials:DPT, PT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 BEDSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-0850
Mailing Address - Country:US
Mailing Address - Phone:540-710-3940
Mailing Address - Fax:
Practice Address - Street 1:928 DIAMOND SPRINGS RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6601
Practice Address - Country:US
Practice Address - Phone:573-951-9757
Practice Address - Fax:757-425-7180
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist