Provider Demographics
NPI:1235338682
Name:DEBOOY, KELLI ELIZABETH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ELIZABETH
Last Name:DEBOOY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:360 E MONTVUE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6318
Mailing Address - Country:US
Mailing Address - Phone:208-855-2900
Mailing Address - Fax:208-898-9877
Practice Address - Street 1:360 E MONTVUE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6318
Practice Address - Country:US
Practice Address - Phone:208-855-2900
Practice Address - Fax:208-898-9877
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2008-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPT2244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1651623Medicare PIN