Basic Information
| Provider Information | |||||||||
| NPI: | 1104929736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIORDANO | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT PHYS THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178658540 | ||||||||
| FaxNumber: | 3178658317 | ||||||||
| Practice Location | |||||||||
| Address1: | 759 45TH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198360193 | ||||||||
| FaxNumber: | 2198362452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05001729A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000000301026 | 01 | IN | BCBS OF IN | OTHER | 200916810 | 05 | IN | MEDICAID | 90000585 | 01 | IL | BCBS OF IL | OTHER |