Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1083105969 |
---|---|
Provider Name | Kelly Coker Dabbs |
First Address | Amory, MS 38821-0134 |
Second Address | Amory, MS 38821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 08/08/2018 |