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Individual

SHAWN KETTYLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1113 EASTON RD, WILLOW GROVE, PA 19090-1901
(215) 659-3060
Mailing address
10225 JAMISON AVE, PHILADELPHIA, PA 19116-3833
(215) 253-0440

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
PA

Other

Enumeration date
12/22/2014
Last updated
12/22/2014
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