Individual
MRS. DEANNA SUE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
35 N 28TH ST, SUPERIOR, WI 54880-5557
(715) 392-3300
Mailing address
4942 THOMPSON RD, HERMANTOWN, MN 55811-3743
(218) 341-5810
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1283-19
WI
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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