Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1194918359 |
---|---|
Provider Name | Mrs. Kelly Ann Masterson |
First Address | Palmyra, PA 17078-8738 |
Second Address | Palmyra, PA 17078-8738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 21/08/2007 |