Provider Demographics
NPI:1760832836
Name:KARR, KELLI MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:MARIE
Last Name:KARR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:MARIE
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:P.O. BOX 637
Mailing Address - Street 2:
Mailing Address - City:ALTAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95221
Mailing Address - Country:US
Mailing Address - Phone:209-736-0956
Mailing Address - Fax:209-736-0958
Practice Address - Street 1:571 STANISLAUS AVE, STE F
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222
Practice Address - Country:US
Practice Address - Phone:209-736-0956
Practice Address - Fax:209-736-0958
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist