Provider Demographics
NPI:1205822996
Name:MUNN, KELLY R (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:R
Last Name:MUNN
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 1:349 HIGHWAY 299 E
Mailing Address - Street 2:
Mailing Address - City:EMMET
Mailing Address - State:AR
Mailing Address - Zip Code:71835-9035
Mailing Address - Country:US
Mailing Address - Phone:870-777-6798
Mailing Address - Fax:870-777-6880
Practice Address - Street 1:501 N HERVEY ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-3435
Practice Address - Country:US
Practice Address - Phone:870-777-6798
Practice Address - Fax:870-777-6880
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist