Provider Demographics
NPI:1144953944
Name:SHEA, KELLY IRELAND (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:IRELAND
Last Name:SHEA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W ROLLING XRDS STE 100-102
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6211
Mailing Address - Country:US
Mailing Address - Phone:410-747-1600
Mailing Address - Fax:
Practice Address - Street 1:2 W ROLLING XRDS STE 100-102
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6211
Practice Address - Country:US
Practice Address - Phone:410-747-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist