Provider Demographics
NPI:1770061376
Name:CONDREN, KELLY ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:CONDREN
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 1:4020 TAYLORSVILLE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1569
Mailing Address - Country:US
Mailing Address - Phone:502-479-2552
Mailing Address - Fax:502-479-2539
Practice Address - Street 1:4020 TAYLORSVILLE RD STE 7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1569
Practice Address - Country:US
Practice Address - Phone:502-479-2552
Practice Address - Fax:502-479-2539
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY454660825OtherPHYSICAL THERAPY OUTPATIENT