KELLY DETHERAGE, PTA

Physical Therapy Assistant

Active Individual
NPI: 1245543966

Practice Address

1201 HOLLAND LAKE DRIVE
Weatherford, TX 76086

Phone: (817) 613-9699

Specialties

Specialty Code Primary License
Physical Therapy Assistant 225200000X Yes 2076950 (TX)

Frequently Asked Questions

NPI 1245543966 is the National Provider Identifier for KELLY DETHERAGE, PTA, a Physical Therapy Assistant provider located in Weatherford, TX. This NPI was enumerated on July 22, 2010.
KELLY DETHERAGE, PTA practices at 1201 HOLLAND LAKE DRIVE, Weatherford, TX 76086.

Quick Facts

NPI
1245543966
Type
Individual
Enumerated
Jul 22, 2010
Last Updated
Jul 22, 2010

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