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General NPI Number Information
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NPI Number | 1063135671
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Entity Type | Individual
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Provider Name | KELLY NICOLE MARCY
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Gender | Female
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 6001 HARRIS PKWY
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City | FORT WORTH
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State | TX
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Zip | 76132-4103
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Country | US
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Telephone | 817-370-6350
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Fax |
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Provider Business Mailing Address
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Address Line | 3451 RIVER PARK DR APT 1413
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City | FORT WORTH
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State | TX
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Zip | 76116-9584
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Country | US
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Telephone | 951-551-1848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2154420
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License Number State | TX
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