Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | AT 9303 | CA |
NPI | 1104215300 |
---|---|
Provider Name | James Kelly |
First Address | Sacramento, CA 95826-2140 |
Second Address | Sacramento, CA 95826-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 12/01/2015 |