Individual
BRYAN KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
930 W RALPH HALL PKWY, STE 120, ROCKWALL, TX 75032-6665
(972) 771-0999
(972) 771-2281
Mailing address
PO BOX 2500, ROCKWALL, TX 75087-9000
(972) 771-0999
(972) 771-2281
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2042026
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165348701
—
TX
Enumeration date
05/03/2012
Last updated
05/03/2012
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