Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-01225 | KS |
NPI | 1003280165 |
---|---|
Provider Name | Kevin Henry |
First Address | Manhattan, KS 66503 |
Second Address | Manhattan, KS 66503-2218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2015 |
Last Update Date | 30/11/2015 |