Provider Demographics
NPI:1538219514
Name:FOX, KELLY MARIE (MPT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:FOX
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1215 E ORANGE ST
Mailing Address - Street 2:PEDIATRIC THERAPY SERVICES, INC.
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5762
Mailing Address - Country:US
Mailing Address - Phone:863-802-3800
Mailing Address - Fax:863-802-0480
Practice Address - Street 1:1215 E ORANGE ST
Practice Address - Street 2:PEDIATRIC THERAPY SERVICES, INC.
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5762
Practice Address - Country:US
Practice Address - Phone:863-802-3800
Practice Address - Fax:863-802-0480
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5995524513OtherTRICARE
FL11185507OtherCITRUS HMO
FLY015BOtherBCBS
FL335046OtherWELLCARE