MEDICARE: MISS KELLY J GEBHART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1669660916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY J GEBHART

Provider Business Mailing Address
First Line	:	PO BOX 681478
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-1478
Country	:	US
Telephone Number	:	866-800-9147
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 N MOUNT JULIET RD
Second Line	:	SUITE 205
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3078
Country	:	US
Telephone Number	:	615-773-0660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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