Provider Demographics
NPI:1497349609
Name:JARRARD, KELLI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:JARRARD
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 1:1730 NE GATEWAY CT APT 203
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-5252
Mailing Address - Country:US
Mailing Address - Phone:319-400-1631
Mailing Address - Fax:
Practice Address - Street 1:1360 NW 18TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9105
Practice Address - Country:US
Practice Address - Phone:515-207-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist