Individual
KELLY MAHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
275 W TIETAN ST, WALLA WALLA, WA 99362-4363
(509) 522-0114
Mailing address
1442 KANIKSU LOOP RD, WALLA WALLA, WA 99362-8742
(360) 201-1009
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61088530
WA
Other
Enumeration date
08/20/2020
Last updated
08/20/2020
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