Provider Demographics
NPI:1912230277
Name:SHEW/JEX, KELLIE K (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:K
Last Name:SHEW/JEX
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:K
Other - Last Name:SHEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-0992
Mailing Address - Country:US
Mailing Address - Phone:970-314-1355
Mailing Address - Fax:
Practice Address - Street 1:756 HILL STREET
Practice Address - Street 2:BOX 992
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641
Practice Address - Country:US
Practice Address - Phone:970-314-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2324225100000X
CO5599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist