Individual
JUSTIN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
8434 CORCORAN RD, WILLOW SPRINGS, IL 60480-1666
(708) 467-0657
(708) 330-5046
Mailing address
8434 CORCORAN RD, WILLOW SPRINGS, IL 60480-1666
(708) 467-0657
(708) 330-5046
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.007134
IL
Other
Enumeration date
07/31/2015
Last updated
08/04/2015
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