Individual
ERIC KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
349 BIDWELL ST, MANCHESTER, CT 06040-6471
(860) 647-9191
(860) 643-6147
Mailing address
4 THERESA ST, EAST LONGMEADOW, MA 01028-1239
(413) 297-2414
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
000275
CT
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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