Provider Demographics
NPI:1003283219
Name:RESHA, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RESHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 SILVER BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8860
Mailing Address - Country:US
Mailing Address - Phone:803-226-9196
Mailing Address - Fax:803-226-9197
Practice Address - Street 1:1393 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8860
Practice Address - Country:US
Practice Address - Phone:803-226-9196
Practice Address - Fax:803-226-9197
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist