Individual
KELLEY GICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2927 LAKE AVE, FORT WAYNE, IN 46805-5415
(260) 469-4148
Mailing address
1900 CAREW ST STE 6, FORT WAYNE, IN 46805-4765
(260) 373-9756
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002002A
IN
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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