Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 60103923 | WA |
NPI | 1053751669 |
---|---|
Provider Name | Katie Buck |
First Address | Yakima, WA 98902-6340 |
Second Address | Yakima, WA 98902-6340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 23/10/2019 |