Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | KS |
NPI | 1003108853 |
---|---|
Provider Name | Kelsea Noel Thompson |
First Address | Leavenworth, KS 66048-1635 |
Second Address | Leavenworth, KS 66048-1635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |