Healthcare Provider Details

I. General information

NPI: 1477095313
Provider Name (Legal Business Name): KELLY DJERNES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 02/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 S 140TH ST
OMAHA NE
68144
US

IV. Provider business mailing address

2510 S 140TH ST
OMAHA NE
68144
US

V. Phone/Fax

Practice location:
  • Phone: 402-618-3320
  • Fax: 402-913-3102
Mailing address:
  • Phone: 402-618-3320
  • Fax: 402-913-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3128
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: