Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PI60046655 | WA |
NPI | 1003156399 |
---|---|
Provider Name | Mrs. Maile Keller |
First Address | Pullman, WA 99163-5512 |
Second Address | Pullman, WA 99163-5512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2013 |
Last Update Date | 22/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PI60046655 | PI60046655 (01) | WA |