Individual
KELLY RANDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
11960 WESTLINE INDUSTRIAL DR, SUITE 201, SAINT LOUIS, MO 63146-3209
(314) 819-0480
(314) 275-7444
Mailing address
11960 WESTLINE INDUSTRIAL DR, SUITE 201, SAINT LOUIS, MO 63146-3209
(314) 819-0480
(314) 275-7444
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
117058
MO
Other
Enumeration date
02/22/2015
Last updated
02/22/2015
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