Individual
MATTHEW KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
535 GREENWOOD AVE SE, EAST GRAND RAPIDS, MI 49506-2901
(616) 635-1267
Mailing address
550 GREENWOOD AVE SE, EAST GRAND RAPIDS, MI 49506-2911
(616) 635-1267
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501001100
MI
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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