Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1609816008 |
---|---|
Provider Name | Ms. Kelly A Jansen |
First Address | Orlando, FL 32803-8208 |
Second Address | Orlando, FL 32803-8208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |