Provider Demographics
NPI:1285961839
Name:KELLEY, KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5767 FOX TRL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6661
Mailing Address - Country:US
Mailing Address - Phone:406-240-3878
Mailing Address - Fax:406-552-4843
Practice Address - Street 1:800 KENSINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5670
Practice Address - Country:US
Practice Address - Phone:406-240-3878
Practice Address - Fax:406-552-4843
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT2066PT2251P0200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies