Clayton Kellerman, PTA
Individual provider Active NPI Physical Therapy Assistant · Osawatomie, KS
NPI 1619418126 · NPPES record last updated Mar 16, 2017
Key facts
- NPI
- 1619418126
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 14-02341 (KS)
- Practice address
- 1615 Parker Ave
Osawatomie, KS 66064-1703 - Phone
- (913) 755-4165
- NPI assigned
- Mar 16, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 14-02341 | KS | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 14-02341 | KS | Yes |
Addresses
Primary practice location
1615 Parker Ave
Osawatomie, KS 66064-1703
Mailing address
12528 S Acuff CT
Olathe, KS 66062-5984
Phone (785) 393-3673
Other providers in Osawatomie, KS
- Laura Lea Henness
- Michael Patrick Herriges
- Homestead of Osawatomie Operations, LLC
- Julie Hurlock
- Olivia Gail Johnson
- Laura Kellerman
- Steven Kinder
- Christopher Shawn Klehammer
- Raemee Knepper
- Ann Rachelle Langton
All providers in Osawatomie, KS · Physical Therapy Assistant in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2017. 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.