Provider Demographics
NPI:1083646061
Name:GERL, KELLY ANN (MPT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:GERL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:DEMELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD STE A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8100
Practice Address - Fax:920-288-8495
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10212024225100000X
IL070014256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40449700Medicaid
WIP00169801OtherRAILROAD MEDICARE NUMBER
ILK16935Medicare ID - Type Unspecified
Q14195Medicare UPIN
ILK16934Medicare ID - Type Unspecified