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General NPI Number Information
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NPI Number | 1194123554
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Entity Type | Individual
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Provider Name | KELLY GEROLD DPT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 303 N HURSTBOURNE PKWY STE 200
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City | LOUISVILLE
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State | KY
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Zip | 40222-5158
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Country | US
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Telephone | 502-412-5847
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 WINTERBERRY DR
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-1068
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Country | US
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Telephone | 765-366-0215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05009750A
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License Number State | IN
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