Individual
BRYAN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3218 DAUGHERTY DR, SUITE 160, LAFAYETTE, IN 47909-3997
(765) 477-6464
(765) 477-6262
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-3251
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05011222A
IN
Other
Enumeration date
06/21/2013
Last updated
08/06/2013
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