Individual
KELLY EILEEN NUGENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17751 PARK VALLEY DR, ROUND ROCK, TX 78681-3592
(512) 218-6013
Mailing address
8525 SHOAL CREEK BLVD APT 102, AUSTIN, TX 78757-7554
(512) 679-7957
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2056880
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2056880
TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
TX
Enumeration date
08/23/2018
Last updated
08/23/2018
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