Provider Demographics
NPI:1861983512
Name:KELLY, ANA ALEJANDRA (PHYSICAL THERAPIST A)
Entity type:Individual
Prefix:MS
First Name:ANA
Middle Name:ALEJANDRA
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 N 59TH AVE APT 273
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-5851
Mailing Address - Country:US
Mailing Address - Phone:623-980-4191
Mailing Address - Fax:
Practice Address - Street 1:5750 N 59TH AVE APT 273
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-5851
Practice Address - Country:US
Practice Address - Phone:623-980-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-013436225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty