Provider Demographics
NPI:1447402649
Name:DODGE, KELLIE J (DPT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:J
Last Name:DODGE
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 1:616 WEST LEOTA ST.
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6532
Mailing Address - Country:US
Mailing Address - Phone:308-534-5590
Mailing Address - Fax:308-534-5570
Practice Address - Street 1:616 WEST LEOTA ST.
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6532
Practice Address - Country:US
Practice Address - Phone:308-534-5590
Practice Address - Fax:308-534-5570
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist