| NPI | 1316457260 |
|---|---|
| Former Name | KELLY ELAINE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61190260) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2025-09-17 |