Individual
DWAIN E KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
10300 W 103RD ST, SUITE 300, OVERLAND PARK, KS 66212
(913) 894-1910
Mailing address
10127 WEDD DR, OVERLAND PARK, KS 66212-5443
(913) 438-2775
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1101441
KS
225100000X
Physical Therapist
R1062
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-01441
STATE PT LICENSE
KS
01
—
R1062
STATE PT LICENSE
MO
Enumeration date
06/06/2008
Last updated
06/06/2008
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