Detherage, Kelly Jean

Detherage, Kelly Jean is an individual health care provider with primary practice located at 1201 Holland Lake Drive , Weatherford TX 76086. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Detherage, Kelly Jean can be contacted via phone (817) 613-9699.

Contact Information

Primary practice address
1201 Holland Lake Drive Weatherford TX 76086
Phone: (817) 613-9699
Fax: (817) 594-9786
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 2076950 Texas

Profile Details

NPI number 1245543966
LBN Legal business name Detherage, Kelly Jean
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2010
Last updated Jul 22nd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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