Individual
KELLY R ANDREWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4101 WICKER RD, BLOOMINGTON, IL 61704
(815) 683-8856
Mailing address
509 W OAKLAND AVE, BLOOMINGTON, IL 61701-5138
(309) 532-1096
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227012881
IL
Other
Enumeration date
06/03/2015
Last updated
06/09/2018
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