Individual
CHARLES KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 OAKWOOD BLVD, ROUND ROCK, TX 78681
(512) 388-7494
Mailing address
401 OAKWOOD BLVD, ROUND ROCK, TX 78681-4067
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2139360
TX
Other
Enumeration date
08/16/2018
Last updated
08/18/2018
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