Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-03781 | KS |
NPI | 1013509702 |
---|---|
Provider Name | Garrett Daniel Bussinger |
First Address | Parsons, KS 67357-8481 |
Second Address | Parsons, KS 67357-3436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2021 |
Last Update Date | 04/02/2021 |