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Individual
KURT R NEELLY
Active
Individual
KURT R NEELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P. T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070011538
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0029040291
IL BLUE CROSS BLUE SHIELD
IL
01
—
10759614
CAQH PROVIDER ID
IL
Enumeration date
01/15/2007
Last updated
11/05/2009
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