| NPI | 1386634137 |
|---|---|
| Former Name | KELLY J VANDENBOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501009867) |
| 225100000X Physical Therapist (Licence: PA PT018699) | |
| 225100000X Physical Therapist (Licence: NC 11392) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2014-05-02 |