Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-00966 | KS |
NPI | 1003892258 |
---|---|
Provider Name | Mrs. Kristie L Hager |
First Address | Fort Leavenworth, KS 66027-2333 |
Second Address | Fort Leavenworth, KS 66027-2333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/07/2007 |