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Individual

MRS. KELLY LYNN KELLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
41088 BAYOU SEGNETTE AVE, GONZALES, LA 70737-8590
(504) 330-9373
Mailing address
41088 BAYOU SEGNETTE AVE, GONZALES, LA 70737-8590

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
07099
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
07099
PT LICENSE
LA
01
12130928
NATIONAL ALLIANCE OF WOUND CARE AND OSTOMY (WCC)
IL
Enumeration date
10/10/2017
Last updated
10/10/2017
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