Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1619585387 |
---|---|
Provider Name | Kelly Faber |
First Address | Fond Du Lac, WI 54935-6375 |
Second Address | St Louis Park, MN 55426-4702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2020 |
Last Update Date | 20/07/2020 |