Individual
JENNIFER MARIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
55 NW WALL ST STE 100, 0, BEND, OR 97703-3200
(541) 389-4321
(541) 389-4420
Mailing address
55 NW WALL ST STE 100, BEND, OR 97703-3200
(541) 389-4321
(541) 389-4420
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1723
AK
225100000X
Physical Therapist
2421
NE
225100000X
Physical Therapist
Primary
4483
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299148
—
OR
Enumeration date
11/30/2005
Last updated
10/07/2016
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