Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 552 | SD |
NPI | 1124271044 |
---|---|
Provider Name | Krista Glanz Minor |
First Address | Belle Fourche, SD 57717-2220 |
Second Address | Belle Fourche, SD 57717-2220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 23/10/2008 |