Individual
DR. MICHAEL THOMAS KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1900 ELECTRIC RD, SALEM, VA 24153-7474
(817) 284-9850
(817) 720-9892
Mailing address
6707 BRENTWOOD STAIR RD STE 600, FORT WORTH, TX 76112-3368
(817) 284-9850
(817) 720-9892
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2011-01909
NC
2081P0004X
Spinal Cord Injury Medicine Physician
2011-01909
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5919524
—
NC
Enumeration date
06/26/2006
Last updated
06/03/2019
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