Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 11-03619 | KS |
NPI | 1003269507 |
---|---|
Provider Name | Emily Tomlinson |
First Address | Prairie Village, KS 66208-3502 |
Second Address | Prairie Village, KS 66208-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 20/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KA1204 | MEDICARE PTAN (01) | KS |