| NPI | 1386701548 |
|---|---|
| Former Name | CAROL ANN KELLCIK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0001914) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CO PTL.0001914) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2017-11-10 |