Individual
MRS. KELLY RAE PRATER WHITMORE
Active
Individual
MRS. KELLY RAE PRATER WHITMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3260
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000837449B
—
GA
01
—
323515
WELLCARE NUMBER
GA
01
—
3260
PT LICENSE NUMBER
GA
Enumeration date
10/15/2006
Last updated
12/13/2017
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