Provider Demographics
NPI:1699459420
Name:SNOW, KELLYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELLYN
Middle Name:
Last Name:SNOW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 POINT BREEZE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-3633
Mailing Address - Country:US
Mailing Address - Phone:774-641-3603
Mailing Address - Fax:
Practice Address - Street 1:128 POINT BREEZE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-3633
Practice Address - Country:US
Practice Address - Phone:774-641-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14326225100000X
MA26662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist