Provider Demographics
NPI:1538616826
Name:KANTER, KELLY WOLF (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:WOLF
Last Name:KANTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 S STEWART ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5233
Mailing Address - Country:US
Mailing Address - Phone:775-445-5757
Mailing Address - Fax:775-885-6696
Practice Address - Street 1:1122 S STEWART ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5233
Practice Address - Country:US
Practice Address - Phone:775-445-5757
Practice Address - Fax:775-885-6696
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist