Healthcare Provider Details

I. General information

NPI: 1083646061
Provider Name (Legal Business Name): KELLY ANN GERL MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KELLY ANN DEMELLE

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD STE A
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8100
  • Fax: 920-288-8495
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10212024
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070014256
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: