| NPI | 1174620611 |
|---|---|
| Former Name | KELIE JEAN PODRATZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7809) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1937) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2018-09-04 |