| Doctor Name: | KRISTA RAE KELLY |
| NPI Number: | 1851751184 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | 61516 |
| Business Practice Address: | 4025 Cherry Ave Ne Keizer, OR - 973034859 |
| Business Phone Number: | 5033909009 |
| Business Fax Number: | |
| Mailing Address: | 210 W Ellendale Ave, Suite 100 DALLAS |
| State: | OR |
| Postal Code: | 973381790 |
| Phone Number: | 5036232196 |
| Fax Number: | |
| NPI Enumeration Date: | 02/29/2016 |
| NPI Last Update Date: | 03/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 61516 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |