Provider Demographics
NPI:1457384596
Name:REILLY, KELLI KAYE (PT, ATC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:KAYE
Last Name:REILLY
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 N 26TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4739
Mailing Address - Country:US
Mailing Address - Phone:402-477-3110
Mailing Address - Fax:
Practice Address - Street 1:4445 S 86TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9225
Practice Address - Country:US
Practice Address - Phone:402-261-4739
Practice Address - Fax:402-261-4972
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2632255A2300X
NE1945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09158OtherBCBS
NE10025058400Medicaid
NE10025058400Medicaid