Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT029313 | PA |
NPI | 1073106217 |
---|---|
Provider Name | Jessica Kelly |
First Address | King Of Prussia, PA 19406-1495 |
Second Address | Levittown, PA 19057-1540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2021 |
Last Update Date | 18/02/2021 |