Provider Demographics
NPI:1427449545
Name:KELLOGG, DENISE M (PTA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:KELLOGG
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 1:51 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1573
Mailing Address - Country:US
Mailing Address - Phone:301-824-1135
Mailing Address - Fax:
Practice Address - Street 1:1423 DUAL HWY
Practice Address - Street 2:SUITE 16F
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6515
Practice Address - Country:US
Practice Address - Phone:301-665-1616
Practice Address - Fax:800-593-1410
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2325225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant