Individual
KELLY LYNN KASSERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1910 RECTOR RD, PARAGOULD, AR 72450-2004
(870) 240-8500
Mailing address
4009 LORI SPENCE, PARAGOULD, AR 72450-2641
(870) 236-8790
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2216
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5W471
BCBS PROVIDER #
AR
Enumeration date
01/23/2007
Last updated
07/08/2007
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