Provider Demographics
NPI:1215038971
Name:ST. CLAIR, KELI NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELI
Middle Name:NICOLE
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 40TH AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4501
Mailing Address - Country:US
Mailing Address - Phone:701-293-7294
Mailing Address - Fax:701-282-9738
Practice Address - Street 1:4674 40TH AVE S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-293-7294
Practice Address - Fax:701-282-9738
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11340225100000X
LAPT07024225100000X
ND1718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H973CK10Medicare PIN