Basic Information
| Provider Information | |||||||||
| NPI: | 1750307401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEAN | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | BAIRD | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524430808 | ||||||||
| FaxNumber: | 2524519032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1223 JULIAN R ALLSBROOK HWY | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278705126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525371215 | ||||||||
| FaxNumber: | 2525371816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 05/28/2009 | ||||||||
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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 | 225100000X | 9539 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.