Individual
MELANI KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
702 3RD AVENUE, CANYON, TX 79015
(360) 623-5259
Mailing address
702 3RD AVE, CANYON, TX 79015-2607
(360) 623-5259
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5735
TX
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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