Individual
MS. KELLY HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
11710 ROSEMOUNT DR, FORT MYERS, FL 33913-8331
(239) 225-1177
Mailing address
11710 ROSEMOUNT DR, FORT MYERS, FL 33913-8331
(239) 225-1177
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1137
FL
Other
Enumeration date
12/27/2011
Last updated
12/27/2011
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