| NPI | 1285176057 |
|---|---|
| Former Name | KELLY HASEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013326A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017989) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2020-12-28 |