Provider Demographics
NPI:1992128755
Name:SALM, KELLI
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:SALM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15553 TANGERINE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3415
Mailing Address - Country:US
Mailing Address - Phone:513-465-0019
Mailing Address - Fax:
Practice Address - Street 1:15553 TANGERINE BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3415
Practice Address - Country:US
Practice Address - Phone:513-465-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-29222225100000X
OHPT-10614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist