Provider Demographics
NPI:1598731523
Name:BEHNEY, KELLY GADWOOD (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:GADWOOD
Last Name:BEHNEY
Suffix:
Gender:F
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:717 N 190TH PLZ
Practice Address - Street 2:STE. 2000
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3913
Practice Address - Country:US
Practice Address - Phone:402-815-2061
Practice Address - Fax:402-815-2062
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025895900Medicaid
NE10025896000Medicaid
NE10025896100Medicaid
NE10026252200Medicaid
NE10026445500Medicaid
IA1598731523Medicaid
NE10025941700Medicaid
NE10026056700Medicaid
NE099099123Medicare PIN