Provider Demographics
NPI:1508318973
Name:KELTNER-JOHNSON, SIERRA RAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:RAE
Last Name:KELTNER-JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:RAE
Other - Last Name:KELTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3007 PICKETT RD APT 318
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6015
Mailing Address - Country:US
Mailing Address - Phone:919-401-5231
Mailing Address - Fax:
Practice Address - Street 1:3007 PICKETT RD APT 318
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6015
Practice Address - Country:US
Practice Address - Phone:919-401-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1256179225100000X
NC16644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist