Provider Demographics
NPI:1598248452
Name:FURNISH, KILEY JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:JEAN
Last Name:FURNISH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N FARLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2420
Mailing Address - Country:US
Mailing Address - Phone:765-667-2428
Mailing Address - Fax:
Practice Address - Street 1:604 RENNAKER ST
Practice Address - Street 2:
Practice Address - City:LA FONTAINE
Practice Address - State:IN
Practice Address - Zip Code:46940-9045
Practice Address - Country:US
Practice Address - Phone:765-981-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99088634A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant