Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
N | 2251X0800X | Physical Therapist - Orthopedic | 11-00650 | KS |
NPI | 1083619175 |
---|---|
Provider Name | Mrs. Kathy Selig |
First Address | Berryton, KS 66409-9312 |
Second Address | Topeka, KS 66604-2459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140722 | BLUE CROSS (01) |