Individual
KELLEY DIPPOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 W MAIN ST, FREEHOLD, NJ 07728-2537
(732) 431-5200
Mailing address
10 ASPEN CT, JACKSON, NJ 08527-4903
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00313900
NJ
Other
Enumeration date
01/29/2015
Last updated
01/29/2015
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