| NPI | 1689866212 |
|---|---|
| Former Name | KELLY NICOLE KOPP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009644) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.016003) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2012-02-13 |