Basic Information
| Provider Information | |||||||||
| NPI: | 1598248452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FURNISH | ||||||||
| FirstName: | KILEY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 N FARLOOK DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469522420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656672428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 604 RENNAKER ST | ||||||||
| Address2: | |||||||||
| City: | LA FONTAINE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469409045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659812081 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2018 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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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 | 225200000X | 99088634A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.