Individual
JENNIFER MARIE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
53940 CARMICHAEL DR, SOUTH BEND, IN 46635-1564
(574) 335-6212
Mailing address
611 E DOUGLAS RD STE 140, MISHAWAKA, IN 46545-1464
(574) 335-6212
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005944A
IN
Other
Enumeration date
01/02/2025
Last updated
01/02/2025
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