Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1104558 | KS |
NPI | 1346653219 |
---|---|
Provider Name | Alexis Nicole Michel |
First Address | Wichita, KS 67206-2249 |
Second Address | Wichita, KS 67226-1128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2014 |
Last Update Date | 08/06/2014 |