Provider Demographics
NPI:1568979979
Name:SADLER, KELLY M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:SADLER
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 1:206 E WALNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1324
Mailing Address - Country:US
Mailing Address - Phone:573-588-4165
Mailing Address - Fax:
Practice Address - Street 1:206 E WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:SHELBINA
Practice Address - State:MO
Practice Address - Zip Code:63468-1324
Practice Address - Country:US
Practice Address - Phone:573-588-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist