Individual
JASON KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
6049 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2160
(804) 639-2359
(804) 639-2029
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305202092
VA
225100000X
Physical Therapist
26834
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
04/13/2006
Last updated
02/12/2019
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