Provider Demographics
NPI:1841480357
Name:KETTER, KEVIN L (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:KETTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17TH STREET AND WELLS
Mailing Address - Street 2:CLARINDA REGIONAL HEALTH CENTER
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632
Mailing Address - Country:US
Mailing Address - Phone:712-542-8224
Mailing Address - Fax:402-274-4840
Practice Address - Street 1:17TH ST.AND WELLS ST.
Practice Address - Street 2:CLARINDA REGIONAL HEALTH CENTER
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632
Practice Address - Country:US
Practice Address - Phone:712-542-8224
Practice Address - Fax:402-274-4840
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist