Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA2690 | AR |
NPI | 1013252311 |
---|---|
Provider Name | Kelley Holland |
First Address | Corning, AR 72422-0511 |
Second Address | Corning, AR 72422-1903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2012 |
Last Update Date | 28/11/2012 |