Individual
MISS KELLY A STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6106 HEALTH CENTER LN, FREDERICKSBURG, VA 22407-6687
(540) 785-1120
Mailing address
6106 HEALTH CENTER LN, FREDERICKSBURG, VA 22407-6687
(540) 785-1120
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603417
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306603417
PTA LICENSE
VA
Enumeration date
06/27/2013
Last updated
06/27/2013
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