Individual
MR. ANDREW EDWARD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
165 N REDWOOD DR, SAN RAFAEL, CA 94903-1969
(415) 499-0278
(415) 499-0297
Mailing address
165 N REDWOOD DR, SAN RAFAEL, CA 94903-1970
(415) 499-0278
(415) 499-0297
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15707
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT15707
BLUE SHIELD IND PROV NO
CA
01
—
ZZZ64636Z
BLUE SHIELD GROUP NUMBER
CA
Enumeration date
07/29/2005
Last updated
07/11/2007
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