Individual
KELLY E WEISNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
124 HAWTHORNE LN, GREENWOOD, IN 46142-9430
(317) 332-9861
Mailing address
124 HAWTHORNE LN, GREENWOOD, IN 46142-9430
(317) 332-9861
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010834A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IN3613
—
IN
Enumeration date
06/12/2020
Last updated
06/12/2020
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