Provider Demographics
NPI:1962544411
Name:MCBRIDE, KELLY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1539
Mailing Address - Country:US
Mailing Address - Phone:410-238-0058
Mailing Address - Fax:
Practice Address - Street 1:214 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-1539
Practice Address - Country:US
Practice Address - Phone:410-238-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160692251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics