Individual
KELLY HIDALGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
122 STROTHER PL, ST SIMONS ISLAND, GA 31522-1876
(678) 463-6621
(912) 466-7233
Mailing address
122 STROTHER PL, ST SIMONS ISLAND, GA 31522-1876
(678) 463-6621
(912) 466-7233
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
7123
GA
2251P0200X
Pediatric Physical Therapist
Primary
7123
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000937087A
—
GA
05
—
000937087C
—
GA
01
—
7123
PHYSICAL THERPAY LICENSE
GA
Enumeration date
12/07/2006
Last updated
03/22/2017
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