Provider Demographics
NPI:1104929736
Name:GIORDANO, KELLY JEANNE (PT PHYS THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JEANNE
Last Name:GIORDANO
Suffix:
Gender:F
Credentials:PT PHYS THERAPIST
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Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:STE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-865-8540
Mailing Address - Fax:317-865-8317
Practice Address - Street 1:759 45TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2938
Practice Address - Country:US
Practice Address - Phone:219-836-0193
Practice Address - Fax:219-836-2452
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2019-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN05001729A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000301026OtherBCBS OF IN
IN200916810Medicaid
IL90000585OtherBCBS OF IL