Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT000431 | PA |
N | 2251E1200X | Ergonomics | ||
N | 225XE1200X | Ergonomics | ||
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251P0200X | Physical Therapist - Pediatrics | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1093702441 |
---|---|
Provider Name | Timothy P Kelly |
First Address | Tamaqua, PA 18252-4431 |
Second Address | Tamaqua, PA 18252-4431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0202760 | HEALTH ASSURANCE (01) | |
03022001 | CAPITAL BLUE CROSS (01) | |
072236 | FIRST PRIORITY HEALTH (01) | |
102808 | HIGHMARK BLUE SHIELD (01) | |
102808 | KEYSTONE (01) | |
11228087 | CAQH (01) | |
2106682 | AETNA HMO (01) | |
43037000 | INDEPENDENCE BLUE CROSS (01) | |
5039607 | AETNA PPO (01) | |
R06074 | (02) |