Provider Demographics
NPI:1740419068
Name:VEIHL, KELLY (PTA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:VEIHL
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 1:804 STATE STREET
Mailing Address - Street 2:#5
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-224-1750
Mailing Address - Fax:217-224-0403
Practice Address - Street 1:804 STATE ST
Practice Address - Street 2:#5
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4951
Practice Address - Country:US
Practice Address - Phone:217-224-1750
Practice Address - Fax:217-224-0403
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-005031225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant