Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 11-02505 | KS |
NPI | 1023142049 |
---|---|
Provider Name | Mrs. Angela Sue Pedrotti |
First Address | Fairway, KS 66205-3301 |
Second Address | Fairway, KS 66205-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |