| NPI | 1902304777 |
|---|---|
| Former Name | KELLY RUTH CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11418) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2021-08-16 |