Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A243 | MN |
NPI | 1003065137 |
---|---|
Provider Name | Kelly Ann Spandl |
First Address | Litchfield, MN 55355-2911 |
Second Address | Litchfield, MN 55355-3340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |