Individual
MARIA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10412 N BAEHR RD, MEQUON, WI 53092-4472
(262) 236-0176
(262) 236-0178
Mailing address
10412 N BAEHR RD, MEQUON, WI 53092-4472
(262) 236-0176
(262) 236-0178
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36119100
—
WI
Enumeration date
07/25/2006
Last updated
12/04/2024
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