Provider Demographics
NPI:1104013770
Name:KISSEL, JANNA LEE (PT)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:LEE
Last Name:KISSEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 TODDSON DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-9202
Mailing Address - Country:US
Mailing Address - Phone:765-653-6718
Mailing Address - Fax:765-653-8930
Practice Address - Street 1:1140 INDIANAPOLIS RD
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1458
Practice Address - Country:US
Practice Address - Phone:765-848-1421
Practice Address - Fax:765-301-4351
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015963225100000X
IN05001368A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05001368AOtherIN LICENSING BOARD