Individual
KELLY TRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12250 TAMIAMI TRL E, NAPLES, FL 34113-8108
(239) 417-0027
Mailing address
7050 SIERRA CLUB CIR APT 3104, NAPLES, FL 34113-7351
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
25441
FL
225200000X
Physical Therapy Assistant
A04036
KY
Other
Enumeration date
04/28/2015
Last updated
08/01/2019
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