Provider Demographics
NPI:1962199612
Name:MURPHY, KELLYN (PTA)
Entity type:Individual
Prefix:
First Name:KELLYN
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KELLYN
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3788 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4346
Mailing Address - Country:US
Mailing Address - Phone:828-423-1898
Mailing Address - Fax:
Practice Address - Street 1:825 RUNYAN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1225
Practice Address - Country:US
Practice Address - Phone:423-875-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7908225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant