| NPI | 1124665492 |
|---|---|
| Former Name | KAJJA MOON KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0016717) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2021-07-30 |