Individual
KELLEY B PENROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT,CCI
Contact information
Practice address
10420 ACORN CT, OSCEOLA, IN 46561-9330
(574) 238-6397
Mailing address
PO BOX 796, GRANGER, IN 46530-0796
(574) 238-6397
(574) 329-5243
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT21304
FL
2251X0800X
Orthopedic Physical Therapist
Primary
05-007738A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891690000
—
FL
01
—
AB762Z
MEDICARE PTAN
FL
Enumeration date
09/16/2006
Last updated
08/26/2013
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