Provider Demographics
NPI:1336171974
Name:KELLEY, REID THOMAS (PT)
Entity type:Individual
Prefix:MR
First Name:REID
Middle Name:THOMAS
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11660 ALPHARETTA HWY STE 560
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3883
Mailing Address - Country:US
Mailing Address - Phone:678-667-3435
Mailing Address - Fax:404-201-2080
Practice Address - Street 1:11660 ALPHARETTA HWY STE 560
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3883
Practice Address - Country:US
Practice Address - Phone:678-667-3435
Practice Address - Fax:404-201-2080
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 3754225100000X
GAPT009889225100000X, 2251S0007X
SC59752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic