| NPI | 1174718738 |
|---|---|
| Former Name | KELLY BLAKE RYDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SC 1770252017) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2024-10-22 |