Provider Demographics
NPI:1932867793
Name:GUILLIES, KELLIE ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:ELIZABETH
Last Name:GUILLIES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 W 140TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3637
Mailing Address - Country:US
Mailing Address - Phone:913-461-3311
Mailing Address - Fax:
Practice Address - Street 1:102 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6019
Practice Address - Country:US
Practice Address - Phone:207-777-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist