Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 11-04665 | KS |
NPI | 1134555162 |
---|---|
Provider Name | Jessica M Duvall |
First Address | Prairie Village, KS 66207-2502 |
Second Address | Prairie Village, KS 66207-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |