Individual
LEVELLA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3856 NOBLE ST, APT 811, JACKSON, MS 39209-4954
(601) 473-4992
Mailing address
3856 NOBLE ST, APT 811, JACKSON, MS 39209-4954
(601) 473-4992
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4733
MS
Other
Enumeration date
06/11/2014
Last updated
06/11/2014
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