Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-01313 | KS |
NPI | 1003112905 |
---|---|
Provider Name | Randall Scott Decker |
First Address | Hillsboro, KS 67063 |
Second Address | Fort Smith, AR 72919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2011 |
Last Update Date | 10/02/2011 |