Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1023118213 |
---|---|
Provider Name | Adena M. Kelly Grove |
First Address | North Charleston, SC 29406-9149 |
Second Address | North Charleston, SC 29406-9149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |