Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 14-01635 | KS |
Y | 225200000X | Physical Therapy Assistant | 666 | NE |
NPI | 1013316405 |
---|---|
Provider Name | Lisa Rettele |
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 | 21/08/2014 |
Last Update Date | 21/08/2014 |