Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-03891 | KS |
NPI | 1013682947 |
---|---|
Provider Name | Braden H Struble |
First Address | Wichita, KS 67202-3017 |
Second Address | Wellington, KS 67152-2802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2021 |
Last Update Date | 17/08/2021 |