Individual
KELLI BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
701 SUNSET HILLS DR, MACON, MO 63552-2165
(660) 385-3113
Mailing address
1001 OLD OLIVE WAY APT 108, CREVE COEUR, MO 63141-5948
(660) 412-2013
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2019042022
MO
Other
Enumeration date
05/21/2020
Last updated
05/21/2020
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