Individual
KELLY MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
44480 W HONEYCUTT RD, #106, MARICOPA, AZ 85138-2903
(520) 582-0142
Mailing address
44480 W HONEYCUTT RD, #106, MARICOPA, AZ 85138-2903
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10553A
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10553A
PHYSICAL THERAPIST ASSISTANT CERTIFICATION
AZ
Enumeration date
11/17/2013
Last updated
11/17/2013
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