Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 11-03731 | KS |
NPI | 1063604189 |
---|---|
Provider Name | Amy L Nichols |
First Address | Lenexa, KS 66214-1505 |
Second Address | Lenexa, KS 66214-1505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 13/08/2007 |