Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1356868814 |
---|---|
Provider Name | Elizabeth Ann Kelly |
First Address | Salt Lake City, UT 84103-2744 |
Second Address | Vancouver, WA 98664-1980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 25/08/2017 |