KELLY JEAN DETHERAGE

WEATHERFORD, TX
NPI1245543966
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: TX  2076950)
Enumeration Date2010-07-22
Last Update Date2010-07-22
Business Address
-- KELLY JEAN DETHERAGE PTA
1201 HOLLAND LAKE DRIVE
WEATHERFORD, TX 76086
Phone number: 817-613-9699
Mailing Address
-- KELLY JEAN DETHERAGE PTA
4560 SE INTERNATIONAL WAY STE. 100
MILWAUKIE, OR 97222
Phone number: 971-206-5200
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