Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 534 | NE |
NPI | 1013046325 |
---|---|
Provider Name | Mr. Travis James Pflaster |
First Address | Omaha, NE 68116-2570 |
Second Address | Overland Park, KS 66214-2658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
534 | STATE LICENSE (01) | NE |