Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT013607 | GA |
NPI | 1558845529 |
---|---|
Provider Name | Dr. Peyton Rose Kelly |
First Address | Atlanta, GA 30319-1042 |
Second Address | Atlanta, GA 30329-2206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2018 |
Last Update Date | 17/09/2018 |