Healthcare Provider Details

I. General information

NPI: 1083258594
Provider Name (Legal Business Name): KEL-PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N PEARL ST STE A
WAYNE NE
68787-1902
US

IV. Provider business mailing address

PO BOX 124
WAYNE NE
68787-0124
US

V. Phone/Fax

Practice location:
  • Phone: 402-999-4564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN E LONGE
Title or Position: PRESIDENT
Credential: MPT, DPT
Phone: 703-946-3227