Provider Demographics
NPI:1730919507
Name:DR. BEN KELLY, DPT, CSCS
Entity type:Organization
Organization Name:DR. BEN KELLY, DPT, CSCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:443-286-7596
Mailing Address - Street 1:3510 EMERALD POINTE DR APT 207B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1365
Mailing Address - Country:US
Mailing Address - Phone:443-286-7596
Mailing Address - Fax:
Practice Address - Street 1:1121 HOLLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2735
Practice Address - Country:US
Practice Address - Phone:443-286-7596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy