Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-01827 | KS |
NPI | 1003031568 |
---|---|
Provider Name | Jean Lewis |
First Address | Topeka, KS 66605-1897 |
Second Address | Topeka, KS 66614-2107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |