| NPI | 1053552158 |
|---|---|
| Former Name | KELLY SUSAN DICKEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01309100) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2017-03-07 |