Individual
JULIA A KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, CHT
Contact information
Practice address
1428 W MEYER RD, WENTZVILLE, MO 63385-3499
(636) 887-3660
(636) 887-3661
Mailing address
607 DEWEY AVE NW, STE 300, GRAND RAPIDS, MI 49504-7335
(616) 356-5000
(616) 356-5001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01829
MO
2251H1200X
Hand Physical Therapist
9611000171
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12325956
CAQH ID
MO
01
—
P00609549
RAILROAD MEDICARE
MO
Enumeration date
05/17/2006
Last updated
07/25/2016
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