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General NPI Number Information
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NPI Number | 1295081354
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Entity Type | Individual
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Provider Name | KELLIE S GOSSMAN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 620 E 25TH ST STE 7
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City | KEARNEY
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State | NE
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Zip | 68847-5529
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Country | US
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Telephone | 308-455-1781
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Fax |
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Provider Business Mailing Address
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Address Line | 2402 UNIVERSITY DR
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City | KEARNEY
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State | NE
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Zip | 68849-4510
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Country | US
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Telephone | 308-865-1143
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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 | 3099
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License Number State | NE
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