Provider Demographics
NPI:1962583526
Name:KELDERMAN, CAROL (DPT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:KELDERMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:ORTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2384 QUEENS AVE
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-9691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1417 A AVE E STE 200
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4202
Practice Address - Country:US
Practice Address - Phone:641-676-3535
Practice Address - Fax:641-676-3537
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist