Individual
KELLY A. LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1180 HOPE ST, BRISTOL, RI 02809-1126
(401) 254-1105
(401) 254-1026
Mailing address
PO BOX 20372, CRANSTON, RI 02920-0944
(401) 785-1016
(401) 785-1018
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00693
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT 00693
STATE LICENSE
RI
Enumeration date
07/02/2008
Last updated
07/02/2008
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