Provider Demographics
NPI:1497057186
Name:KELLEY, CHERISE (PT)
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11133 O ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2337
Mailing Address - Country:US
Mailing Address - Phone:800-259-9897
Mailing Address - Fax:800-259-0287
Practice Address - Street 1:11133 O ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2337
Practice Address - Country:US
Practice Address - Phone:800-259-9897
Practice Address - Fax:800-259-0287
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1190426225100000X
NE2493225100000X
IA004599225100000X
CA35608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist