Provider Demographics
NPI:1982083523
Name:NACE, KELLIANNE SHELLER (MPT)
Entity Type:Individual
Prefix:
First Name:KELLIANNE
Middle Name:SHELLER
Last Name:NACE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-9307
Mailing Address - Country:US
Mailing Address - Phone:484-624-4559
Mailing Address - Fax:
Practice Address - Street 1:73 SAGE DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-9307
Practice Address - Country:US
Practice Address - Phone:484-624-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012866L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist