Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 2002022537 | MO |
NPI | 1376923730 |
---|---|
Provider Name | Benjamin Kuster |
First Address | Jefferson City, MO 65109-0786 |
Second Address | Jefferson City, MO 65109-6896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 01/06/2015 |