Individual
KELLY DE LEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
710 S BUSINESS 54, FULTON, MO 65251-1403
(573) 642-9999
Mailing address
710 S BUSINESS 54, FULTON, MO 65251-1403
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2004026340
MO
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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