Provider Demographics
NPI:1376252866
Name:KELLNER, JUDITH KAREN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:KAREN
Last Name:KELLNER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:KAREN
Other - Last Name:KELLNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:27480 742ND AVE
Mailing Address - Street 2:
Mailing Address - City:DASSEL
Mailing Address - State:MN
Mailing Address - Zip Code:55325-3200
Mailing Address - Country:US
Mailing Address - Phone:320-237-6840
Mailing Address - Fax:
Practice Address - Street 1:600 S DAVIS AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3431
Practice Address - Country:US
Practice Address - Phone:320-693-2472
Practice Address - Fax:320-593-2997
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist