Provider Demographics
NPI:1790199925
Name:SAUTER, KELLIE (DPT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:SAUTER
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 1:4725 MERLE HAY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-331-3190
Mailing Address - Fax:515-331-3191
Practice Address - Street 1:1220 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4049
Practice Address - Country:US
Practice Address - Phone:319-366-8701
Practice Address - Fax:319-896-4342
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist