Provider Demographics
NPI:1972716975
Name:KAMARAD, KELLY MARIE (DPT, PT, MS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:KAMARAD
Suffix:
Gender:F
Credentials:DPT, PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SHADOW MOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5932
Mailing Address - Country:US
Mailing Address - Phone:307-635-4479
Mailing Address - Fax:
Practice Address - Street 1:3718 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1246
Practice Address - Country:US
Practice Address - Phone:307-635-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10542251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics