Provider Demographics
NPI:1639557101
Name:GOERTZEN, KELLEN (DPT)
Entity type:Individual
Prefix:DR
First Name:KELLEN
Middle Name:
Last Name:GOERTZEN
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 1:13809 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137
Mailing Address - Country:US
Mailing Address - Phone:402-932-7111
Mailing Address - Fax:402-932-6878
Practice Address - Street 1:310 E GOLD COAST RD
Practice Address - Street 2:STE 113
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:402-504-6506
Practice Address - Fax:402-504-6509
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1259107225100000X
NE3957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist