Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 007700-1 | NY |
NPI | 1003061433 |
---|---|
Provider Name | Barbara Jean Kelly-Kinney |
First Address | Rose, NY 14542-0039 |
Second Address | Penn Yan, NY 14527-1832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2008 |
Last Update Date | 26/11/2008 |