Individual
KELLEY J BANNERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
768 HUEY LN, THE VILLAGES, FL 32162-7442
(585) 429-0603
Mailing address
768 HUEY LN, THE VILLAGES, FL 32162-7442
(585) 429-0603
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29214
FL
Other
Enumeration date
04/07/2025
Last updated
04/07/2025
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