Provider Demographics
NPI:1215485099
Name:CROSS, KELLY (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MATHIAS DR STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0710
Mailing Address - Country:US
Mailing Address - Phone:479-332-4100
Mailing Address - Fax:479-332-4092
Practice Address - Street 1:1110 MATHIAS DR STE C
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0710
Practice Address - Country:US
Practice Address - Phone:479-332-4100
Practice Address - Fax:479-332-4092
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist