| NPI | 1063820157 |
|---|---|
| Former Name | CASEY ALYSON KELLOGG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT29479) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2018-11-16 |