Provider Demographics
NPI:1538774096
Name:BIASIOLLI, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BIASIOLLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLONIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1363
Mailing Address - Country:US
Mailing Address - Phone:817-807-6590
Mailing Address - Fax:
Practice Address - Street 1:101 COLONIAL PKWY
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-1363
Practice Address - Country:US
Practice Address - Phone:817-807-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12096225700000X
CA80177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist