Individual
DEREK KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT/AOP
Contact information
Practice address
3800 SHAMROCK DR, CHARLOTTE, NC 28215-3220
(704) 532-5462
(704) 532-5387
Mailing address
4833 MEADOWRIDGE DR, CHARLOTTE, NC 28226-1214
(704) 999-4734
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14094
NC
Other
Enumeration date
11/07/2013
Last updated
03/17/2018
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