Provider Demographics
NPI:1104496181
Name:ULRICH, KELLI (DPT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 KANSAS RD
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-2505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 WHITE WAY ST
Practice Address - Street 2:
Practice Address - City:NETAWAKA
Practice Address - State:KS
Practice Address - Zip Code:66516-9323
Practice Address - Country:US
Practice Address - Phone:785-285-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist