Provider Demographics
NPI:1508195322
Name:KINLER, KELLY LYNNE (P T)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNNE
Last Name:KINLER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 MAGAZINE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5233
Mailing Address - Country:US
Mailing Address - Phone:337-519-1289
Mailing Address - Fax:
Practice Address - Street 1:2906 MAGAZINE DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5233
Practice Address - Country:US
Practice Address - Phone:337-519-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist