Individual
LISA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,CERT.MDT,COMT
Contact information
Practice address
420 BAINBRIDGE ST, PHILADELPHIA, PA 19147-1568
(215) 629-1270
(215) 629-5531
Mailing address
28 COUNTRY LN, GLEN MILLS, PA 19342-1436
(610) 724-8708
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT009484-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT009484-L
PT LICENSE NUMBER
PA
Enumeration date
08/02/2005
Last updated
10/13/2022
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