Provider Demographics
NPI:1285971481
Name:PIERCE, KELLEY (PTA)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 KENNETH LN
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5133
Mailing Address - Country:US
Mailing Address - Phone:470-248-8688
Mailing Address - Fax:
Practice Address - Street 1:5240 SNAPFINGER PARK DR STE 130
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4054
Practice Address - Country:US
Practice Address - Phone:770-322-7003
Practice Address - Fax:770-322-7630
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000743225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant