Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | 004098 | OH |
Y | 2251N0400X | Physical Therapist - Neurology | PT0022335 | PA |
NPI | 1194061390 |
---|---|
Provider Name | Mr. Daniel Brian Kelly |
First Address | Erie, PA 16508-2903 |
Second Address | Erie, PA 16508-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2012 |
Last Update Date | 17/12/2012 |