Healthcare Provider Details

I. General information

NPI: 1942641022
Provider Name (Legal Business Name): KELAN DOUGLAS KROHE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 86TH ST
URBANDALE IA
50322-4201
US

IV. Provider business mailing address

2901 86TH ST
URBANDALE IA
50322-4201
US

V. Phone/Fax

Practice location:
  • Phone: 515-276-3406
  • Fax:
Mailing address:
  • Phone: 515-276-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005241
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number005241
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: