Provider Demographics
NPI:1053978676
Name:LAY, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8213 ROYAL STAR CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3860
Mailing Address - Country:US
Mailing Address - Phone:443-974-0108
Mailing Address - Fax:
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3956
Practice Address - Country:US
Practice Address - Phone:410-544-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist