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General NPI Number Information
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NPI Number | 1679525570
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Entity Type | Individual
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Provider Name | JULIA A KELLOGG PT, CHT
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 1428 W MEYER RD
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City | WENTZVILLE
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State | MO
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Zip | 63385-3499
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Country | US
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Telephone | 636-887-3660
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Fax | 636-887-3661
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Provider Business Mailing Address
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Address Line | 607 DEWEY AVE NW STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-7335
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Country | US
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Telephone | 616-356-5000
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Fax | 616-356-5001
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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 | 01829
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number | 9611000171
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License Number State | MO
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