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General NPI Number Information
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NPI Number | 1083258594
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Entity Type | Organization
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Legal Business Name | KEL-PT LLC
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 214 N PEARL ST STE A
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City | WAYNE
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State | NE
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Zip | 68787-1902
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Country | US
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Telephone | 402-999-4564
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | WAYNE
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State | NE
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Zip | 68787-0124
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN E LONGE
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Credential | MPT, DPT
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Telephone | 703-946-3227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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