Healthcare Provider Details

I. General information

NPI: 1821300377
Provider Name (Legal Business Name): KELLI JO CHESNUT DOERN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8254 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

IV. Provider business mailing address

2520 WHITECASTLE DR
MIDLOTHIAN VA
23113-6030
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-5357
  • Fax: 804-560-7962
Mailing address:
  • Phone: 319-321-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305208493
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1196330
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: