Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-03166 | KS |
NPI | 1013455716 |
---|---|
Provider Name | Lina Jaramillo-Cisneros |
First Address | Overland Park, KS 66215-2269 |
Second Address | Overland Park, KS 66202-4028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2017 |
Last Update Date | 02/02/2017 |