Individual
MRS. KELLY DENISE EALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
5606 S 147TH ST, OMAHA, NE 68137-2648
(402) 715-8200
Mailing address
5606 S 147TH ST, OMAHA, NE 68137-2648
(402) 715-8200
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2262
NEBRASKA STATE LICENSE 2262
NE
Enumeration date
11/04/2015
Last updated
11/04/2015
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