Provider Demographics
NPI:1558610782
Name:HUGHES, KELLEN EUGENE (DPT)
Entity Type:Individual
Prefix:
First Name:KELLEN
Middle Name:EUGENE
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18483 W JUDO RD
Mailing Address - Street 2:
Mailing Address - City:BRAMAN
Mailing Address - State:OK
Mailing Address - Zip Code:74632-9238
Mailing Address - Country:US
Mailing Address - Phone:361-876-9922
Mailing Address - Fax:
Practice Address - Street 1:103 W 13TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3224
Practice Address - Country:US
Practice Address - Phone:918-786-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist