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General NPI Number Information
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NPI Number | 1831419365
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Entity Type | Individual
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Provider Name | KELLY RICHARD HARROLD LPT
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Gender | Male
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 120 E 5TH ST
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City | TIPTON
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State | IA
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Zip | 52772-1731
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Country | US
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Telephone | 563-886-3421
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Fax | 563-886-2083
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Provider Business Mailing Address
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Address Line | 2401 TOWNCREST DR
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City | IOWA CITY
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State | IA
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Zip | 52240-6631
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Country | US
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Telephone | 319-354-2429
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Fax | 319-354-6100
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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 | 004537
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License Number State | IA
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