| NPI | 1639554801 |
|---|---|
| Former Name | KELLY LYNN AMMONS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: TN 8560) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8560) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2015-07-29 |