Provider Demographics
NPI:1215284518
Name:LAWTON, KELLIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:LAWTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10730 NALL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1202
Mailing Address - Country:US
Mailing Address - Phone:913-385-0075
Mailing Address - Fax:913-385-0076
Practice Address - Street 1:10730 NALL AVE STE 204
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-385-0075
Practice Address - Fax:913-385-0076
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist