Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11-03317 | KS |
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1063417111 |
---|---|
Provider Name | Mrs. Amy Newbery |
First Address | Topeka, KS 66614-4596 |
Second Address | Topeka, KS 66618-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140667 | BLUE CROSS (01) |