Provider Demographics
NPI:1154496107
Name:WERNER, KELLY DIANE
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DIANE
Last Name:WERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-255-6814
Mailing Address - Fax:814-255-7963
Practice Address - Street 1:COLLEGE PARK PLAZA
Practice Address - Street 2:SUITE 540
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931
Practice Address - Country:US
Practice Address - Phone:814-472-9070
Practice Address - Fax:814-472-9067
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist