Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05001092A | IN |
N | 2251X0800X | Physical Therapist - Orthopedic | 05001092A | IN |
NPI | 1023481124 |
---|---|
Provider Name | Gail Altekruse |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2015 |
Last Update Date | 11/01/2021 |