Provider Demographics
NPI:1518255157
Name:GEUTING, KELLIE DIANNE (PT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:DIANNE
Last Name:GEUTING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:DIANNE
Other - Last Name:TAPPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1954 ROCKLEDGE BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3761
Mailing Address - Country:US
Mailing Address - Phone:321-433-1500
Mailing Address - Fax:321-433-1556
Practice Address - Street 1:1954 ROCKLEDGE BLVD STE 119
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3761
Practice Address - Country:US
Practice Address - Phone:321-433-1500
Practice Address - Fax:321-433-1556
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002716174400000X
FLPT28376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist