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 |