Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1399 | NE |
NPI | 1003287392 |
---|---|
Provider Name | Megan Svoboda |
First Address | Scottsbluff, NE 69361-1657 |
Second Address | Scottsbluff, NE 69361-1893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2015 |
Last Update Date | 12/10/2015 |