| NPI | 1922455328 |
|---|---|
| Former Name | KELLY MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4039) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1275430) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2023-06-26 |