Individual
MRS. KELLY SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 ANDERSON RD STE C, GREENVILLE, SC 29611-7651
(864) 295-9890
Mailing address
300 DUNHILL DR, ANDERSON, SC 29625-5209
(864) 375-1235
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1953
SC
Other
Enumeration date
04/22/2007
Last updated
07/08/2007
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