Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-01975 | KS |
NPI | 1013221514 |
---|---|
Provider Name | Kristel Bontrager |
First Address | Hiawatha, KS 66434-2232 |
Second Address | Hiawatha, KS 66434-2232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 22/09/2010 |