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Individual

DERK KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT,DPT

Contact information

Practice address
6004 W WELLS ST, WAUWATOSA, WI 53213-3244
(804) 349-5941
Mailing address
6004 W WELLS ST, WAUWATOSA, WI 53213-3244
(804) 349-5941

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12071-24
WI

Other

Enumeration date
07/17/2012
Last updated
07/17/2012
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