| NPI | 1326595760 |
|---|---|
| Former Name | KELLIE CELESTE MCMAHON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 14139363-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 4362) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2025-02-21 |