Individual
KELLY HAAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1802 N JACKSON ST, SUITE 820, TULLAHOMA, TN 37388-8218
(931) 455-5335
Mailing address
599 OLD SEMINARY RD, MANCHESTER, TN 37355-7705
(931) 728-8601
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2279
LICENSE #
TN
Enumeration date
08/30/2006
Last updated
07/08/2007
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