Healthcare Provider Details

I. General information

NPI: 1457384596
Provider Name (Legal Business Name): KELLI KAYE REILLY PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S 86TH ST STE 100
LINCOLN NE
68526-9225
US

IV. Provider business mailing address

4911 N 26TH ST STE 100
LINCOLN NE
68521-4739
US

V. Phone/Fax

Practice location:
  • Phone: 402-261-4739
  • Fax: 402-261-4972
Mailing address:
  • Phone: 402-477-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number263
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1945
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: