Individual
KELLY LEIGH KIERSTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
515 FAIRVIEW AVE, CANON CITY, CO 81212-2863
(719) 275-0665
Mailing address
PO BOX 161, ROCKVALE, CO 81244-0161
(719) 225-3967
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0012399
CO
Other
Enumeration date
09/24/2021
Last updated
09/24/2021
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