Provider Demographics
NPI:1487078226
Name:KELLEY, PEYTON (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:PEYTON
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3527
Mailing Address - Country:US
Mailing Address - Phone:804-402-5806
Mailing Address - Fax:
Practice Address - Street 1:6908 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3527
Practice Address - Country:US
Practice Address - Phone:804-402-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist