Provider Demographics
NPI:1003064775
Name:KLOEPPING, KELLY ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANNE
Last Name:KLOEPPING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S.E. GREENVILLE BLVD.
Mailing Address - Street 2:B-3
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5758
Mailing Address - Country:US
Mailing Address - Phone:252-215-5225
Mailing Address - Fax:252-215-5226
Practice Address - Street 1:308 S.E. GREENVILLE BLVD.
Practice Address - Street 2:B-3
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5758
Practice Address - Country:US
Practice Address - Phone:252-215-5225
Practice Address - Fax:252-215-5226
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018158225200000X
NC4230225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant