Provider Demographics
NPI:1144039595
Name:KELLY, ASHLYN ROCHELLE (DPT, PT)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:ROCHELLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20225 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1769
Mailing Address - Country:US
Mailing Address - Phone:313-882-6419
Mailing Address - Fax:313-882-6470
Practice Address - Street 1:20225 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1769
Practice Address - Country:US
Practice Address - Phone:313-882-6419
Practice Address - Fax:313-882-6470
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist