Individual
MR. MARK KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
394 N SUNCOAST BLVD, STE 40, CRYSTAL RIVER, FL 34429-5466
(352) 795-6225
(352) 795-6065
Mailing address
8455 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5066
(352) 795-6225
(352) 795-6065
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA21605
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106898
MEDICARE ID
FL
Enumeration date
09/02/2009
Last updated
09/02/2009
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