Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2017036517 | MO |
NPI | 1013476530 |
---|---|
Provider Name | Mrs. Sierra Nicole Gragg |
First Address | Minot, ND 58701-4499 |
Second Address | Minot, ND 58701-4499 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 14/03/2019 |