Provider Demographics
NPI:1003536723
Name:SOBIECH, KELLEN ELIZABETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:KELLEN
Middle Name:ELIZABETH
Last Name:SOBIECH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-0551
Mailing Address - Country:US
Mailing Address - Phone:484-394-5639
Mailing Address - Fax:
Practice Address - Street 1:923 ROUTE 41
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9601
Practice Address - Country:US
Practice Address - Phone:484-294-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty