Individual
MRS. KELLY MARIE HAISLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
13420 5C RD, PLYMOUTH, IN 46563-7768
(574) 276-6476
Mailing address
13420 5C RD, PLYMOUTH, IN 46563-7768
(574) 276-6476
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004015A
IN
225200000X
Physical Therapy Assistant
2306605011
VA
Other
Enumeration date
05/28/2018
Last updated
05/28/2018
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