Individual
KELLY CARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4100 14TH ST NE, SAINT PETERSBURG, FL 33703-5328
(727) 455-8305
Mailing address
35746 HARPER AVE, CLINTON TWP, MI 48035-3212
(813) 455-9621
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1988
FL
Other
Enumeration date
05/06/2011
Last updated
05/06/2011
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