Provider Demographics
NPI:1447546585
Name:BENES, KELLEN JOHN (DPT)
Entity type:Individual
Prefix:
First Name:KELLEN
Middle Name:JOHN
Last Name:BENES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 B ST
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-1942
Mailing Address - Country:US
Mailing Address - Phone:402-747-1434
Mailing Address - Fax:402-747-1405
Practice Address - Street 1:531 BEEBE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:NE
Practice Address - Zip Code:68651-5537
Practice Address - Country:US
Practice Address - Phone:402-747-1434
Practice Address - Fax:402-747-1405
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist