Individual
KELLEY NICHELLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
38051 MARKET SQ, ZEPHYRHILLS, FL 33542-7504
(813) 779-2057
(813) 779-2066
Mailing address
38135 MARKET SQ, ZEPHYRHILLS, FL 33542-7505
(813) 780-1255
(813) 780-9773
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA19233
FL
Other
Enumeration date
09/24/2007
Last updated
09/24/2007
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