Provider Demographics
NPI:1356596498
Name:KILLEEN, KELLI (DPT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:KILLEEN
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 85
Mailing Address - Street 2:STE 302
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-0085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 HWY 88
Practice Address - Street 2:NO 302
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423
Practice Address - Country:US
Practice Address - Phone:775-782-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22662251X0800X
CA304372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic