Basic Information
| Provider Information | |||||||||
| NPI: | 1396918843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | RENEE | ||||||||
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| Credential: | MS PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 LITTLE SILVER POINT RD | ||||||||
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| City: | LITTLE SILVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077391531 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 BRIDGEWATERS DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | OCEANPORT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077571162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325426600 | ||||||||
| FaxNumber: | 7325426606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2008 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 40QA00890800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.