Provider Demographics
NPI:1750740379
Name:BLOW, KELLIE L (DPT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:BLOW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:L
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:784 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7726
Practice Address - Country:US
Practice Address - Phone:636-349-8060
Practice Address - Fax:636-349-9171
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist