Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | KS 11-01929 | KS |
NPI | 1063634368 |
---|---|
Provider Name | Mrs. Elizabeth Hesse Fetter |
First Address | Overland Park, KS 66213-3608 |
Second Address | Shawnee Mission, KS 66204-2210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |