Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-01778 | KS |
NPI | 1003265141 |
---|---|
Provider Name | Teri Raub |
First Address | Abilene, KS 67410-1547 |
Second Address | Abilene, KS 67410-1547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 09/06/2016 |