Provider Demographics
NPI:1164080818
Name:FLETCHER, KAREY JO (PT)
Entity Type:Individual
Prefix:
First Name:KAREY
Middle Name:JO
Last Name:FLETCHER
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 1:18715 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-2160
Mailing Address - Country:US
Mailing Address - Phone:402-350-5266
Mailing Address - Fax:402-334-6844
Practice Address - Street 1:1454 30TH ST STE 103
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1312
Practice Address - Country:US
Practice Address - Phone:515-223-6620
Practice Address - Fax:515-223-9625
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03485225100000X
NE2253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2253OtherPHYSICAL THERAPY LICENSE
IA03485OtherPHYSICAL THERAPY LICENSE