Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2451PTA | MT |
NPI | 1003189119 |
---|---|
Provider Name | Kaycee L Beall |
First Address | Great Falls, MT 59405-5201 |
Second Address | Great Falls, MT 59405-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |