Provider Demographics
NPI:1821300377
Name:DOERN, KELLI JO CHESNUT (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:JO CHESNUT
Last Name:DOERN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2520 WHITECASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6030
Mailing Address - Country:US
Mailing Address - Phone:319-321-2898
Mailing Address - Fax:
Practice Address - Street 1:8254 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-764-5357
Practice Address - Fax:804-560-7962
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052084932251N0400X
TX11963302251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology