Individual
BRIAN P KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, SCS, ATC
Contact information
Practice address
415 CROSSLAKE DR STE B, EVANSVILLE, IN 47715
(812) 476-0409
(812) 476-1016
Mailing address
PO BOX 5629, EVANSVILLE, IN 47716-5629
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05005037A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000197256
BLUE CROSS BLUE SHIELD
IN
05
—
200839360
—
IN
Enumeration date
12/05/2005
Last updated
01/30/2019
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