Individual
KELLY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10385 COMMERCE DR, SUITE22, CARMEL, IN 46032-7630
(317) 660-1342
Mailing address
3528 ALPINE PL, INDIANAPOLIS, IN 46226-6441
(317) 918-9043
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT20902165
IN
Other
Enumeration date
10/10/2012
Last updated
10/10/2012
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