Individual
KELLI A GOEDDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, OCS
Contact information
Practice address
7300 E INDIANA ST, STE. 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Mailing address
7300 E INDIANA ST, STE. 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05003223A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092829
BLUE CROSS BLUE SHIELD
IN
05
—
200839520
—
IN
Enumeration date
12/02/2005
Last updated
12/29/2008
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