Individual
MR. JOHN B KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
11424 SULLIVAN RD, BLDG C STE A, BATON ROUGE, LA 70818
(225) 261-7021
(225) 262-7826
Mailing address
2335 CHURCH ST, STE G, ZACHARY, LA 70791
(225) 654-8208
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022578
—
LA
01
—
3A115C943
MEDICARE
LA
Enumeration date
11/16/2006
Last updated
06/13/2008
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