Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 00506 | IA |
NPI | 1013175405 |
---|---|
Provider Name | Mrs. Traci Ann Hepker |
First Address | Des Moines, IA 50315 |
Second Address | Des Moines, IA 50315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 02/06/2008 |