Individual
MR. GARY LEE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
711 RUSH AVE, BELLEFONTAINE, OH 43311
(937) 592-1625
(937) 592-3489
Mailing address
711 RUSH AVE, BELLEFONTAINE, OH 43311
(937) 592-1625
(937) 592-3489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT08693
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000201029
ANTHEM
OH
05
—
2322187
—
OH
Enumeration date
09/07/2006
Last updated
07/08/2007
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