Healthcare Provider Details

I. General information

NPI: 1649104779
Provider Name (Legal Business Name): KELLY BLANC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N MONITOR ST
WEST POINT NE
68788-1555
US

IV. Provider business mailing address

102 CIRCLE DR
OAKLAND NE
68045-1520
US

V. Phone/Fax

Practice location:
  • Phone: 402-372-2372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: