Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 610-019 | WI |
NPI | 1003930363 |
---|---|
Provider Name | Kayce J Thompson |
First Address | Beloit, WI 53511-1842 |
Second Address | Beloit, WI 53511-1842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 22/08/2007 |