Individual
KELLY JO MATTILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1022 PRESIDENTIAL CORRIDOR, CALDWELL, TX 77836-4611
(979) 567-0920
Mailing address
5025 WELCOME LN, COLLEGE STATION, TX 77845-9528
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2122317
TX
Other
Enumeration date
03/22/2017
Last updated
03/22/2017
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