Kelly P. Bagalawis, P.T.
Individual provider Active NPI Physical Therapist · Marion, IL
NPI 1437480613 · NPPES record last updated Jan 27, 2010
Key facts
- NPI
- 1437480613
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070017544 (IL)
- Practice address
- 2219B Nichole LN
Marion, IL 62959-4715 - Phone
- (618) 751-4019
- NPI assigned
- Jan 27, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070017544 | IL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070017544 | IL | Yes |
Addresses
Primary practice location
2219B Nichole LN
Marion, IL 62959-4715
Mailing address
2219B Nichole LN
Marion, IL 62959-4715
Phone (618) 751-4019
Other providers in Marion, IL
- Brenda Rose Austin
- Ashley Aylesworth
- Back N Motion Rehab Services LLC
- Kofoworola Olanike Badejo
- Gary E Baer
- Brett David Baird
- Christina Baird
- Mitchell Baker
- Tiffany Baldi
- Brittny Banks
All providers in Marion, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.