| NPI | 1346752243 |
|---|---|
| Former Name | KELLY NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT026401) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2024-12-20 |