Individual
GRACE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
850 PAPER MILL RD, GLENSIDE, PA 19038-7833
(215) 233-0920
Mailing address
629 N WALES RD, NORTH WALES, PA 19454-1724
(215) 630-1788
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE000562L
PA
Other
Enumeration date
11/14/2009
Last updated
11/14/2009
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