Provider Demographics
NPI:1336477462
Name:KELLAR, TERRI CHRISTINE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:TERRI
Middle Name:CHRISTINE
Last Name:KELLAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 N DALE MABRY HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3269
Mailing Address - Country:US
Mailing Address - Phone:813-443-4623
Mailing Address - Fax:813-443-4624
Practice Address - Street 1:7829 N DALE MABRY HWY STE 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3269
Practice Address - Country:US
Practice Address - Phone:813-443-4623
Practice Address - Fax:813-443-4624
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNPI0004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist