Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1350516 | TX |
NPI | 1053082073 |
---|---|
Provider Name | Dr. Kelsey Patricia Green |
First Address | Round Rock, TX 78665-1032 |
Second Address | Round Rock, TX 78665-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |