Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2017025031 | MO |
NPI | 1013432053 |
---|---|
Provider Name | Katie Martin |
First Address | Merriam, KS 66204-2218 |
Second Address | Merriam, KS 66204-2218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2017 |
Last Update Date | 10/08/2017 |