Healthcare Provider Details

I. General information

NPI: 1346578432
Provider Name (Legal Business Name): KELLY LYNN MONSMA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY LYNN MEADE

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 E FIR AVE STE 102
FRESNO CA
93720
US

IV. Provider business mailing address

1903 E FIR AVE STE 102
FRESNO CA
93720-3862
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-1703
  • Fax: 559-322-1793
Mailing address:
  • Phone: 559-322-1703
  • Fax: 559-322-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032145-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: