Provider Demographics
NPI:1427060359
Name:BROWN GROSS, KELLY MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:BROWN GROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:5950 UNIVERSITY AVE STE 385
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8216
Practice Address - Country:US
Practice Address - Phone:515-875-9706
Practice Address - Fax:515-875-9707
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03664OtherPROFESSIONAL LICENSE NUMB