Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0545 | SD |
NPI | 1003068719 |
---|---|
Provider Name | Mrs. Pamela Kaye Fedders |
First Address | Yankton, SD 57078-1962 |
Second Address | Yankton, SD 57078-1962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2008 |
Last Update Date | 14/10/2008 |