| NPI | 1902325848 |
|---|---|
| Former Name | KELLIE LOUISE SHREVE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: WA PT60723998) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT6382) |
| 225100000X Physical Therapist (Licence: WA PT60723998) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2021-07-20 |