Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | ||
Y | 2251P0200X | Physical Therapist - Pediatrics | 1210949 | TX |
NPI | 1124475694 |
---|---|
Provider Name | Mrs. Carrie Kelly |
First Address | Terrell, TX 75160-8867 |
Second Address | Terrell, TX 75160-8867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2016 |
Last Update Date | 10/01/2022 |