Provider Demographics
NPI:1275795031
Name:CROLL, KELLI DUNCAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:DUNCAN
Last Name:CROLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9101 BURNET RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5254
Mailing Address - Country:US
Mailing Address - Phone:512-248-2422
Mailing Address - Fax:512-248-2354
Practice Address - Street 1:9101 BURNET RD STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5260
Practice Address - Country:US
Practice Address - Phone:512-248-2422
Practice Address - Fax:512-248-2354
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11815092251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics