Provider Demographics
NPI:1346401239
Name:CONNELLY, KARI L (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:L
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-483-9534
Mailing Address - Fax:402-486-9098
Practice Address - Street 1:5401 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2150
Practice Address - Country:US
Practice Address - Phone:402-483-9534
Practice Address - Fax:402-486-9098
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470439599-02Medicaid