Provider Demographics
NPI:1144484403
Name:KELLY, JOAN RITCHIE (MHS, PT)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:RITCHIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:ELAINE
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PT
Mailing Address - Street 1:6008 BROWNSBORO PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1295
Mailing Address - Country:US
Mailing Address - Phone:502-899-4760
Mailing Address - Fax:
Practice Address - Street 1:6008 BROWNSBORO PARK BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1295
Practice Address - Country:US
Practice Address - Phone:502-899-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist