Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-02420 | KS |
NPI | 1003202045 |
---|---|
Provider Name | Reesa Volgamore |
First Address | Andover, KS 67002-8498 |
Second Address | Andover, KS 67002-8498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 23/04/2015 |