| NPI | 1649394941 |
|---|---|
| Former Name | KELLY DAWN DEGENHARDT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01140000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 017307) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2009-01-17 |