Provider Demographics
NPI:1386728327
Name:KELLEY, DAWN R (PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-5303
Mailing Address - Country:US
Mailing Address - Phone:620-221-1990
Mailing Address - Fax:620-221-4523
Practice Address - Street 1:1913 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-5303
Practice Address - Country:US
Practice Address - Phone:620-221-1990
Practice Address - Fax:620-221-4523
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141047OtherBC/BS PROVIDER NUMBER
KS141047Medicare ID - Type Unspecified