Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-02270 | KS |
NPI | 1013293141 |
---|---|
Provider Name | Tiffany Pakkebier |
First Address | Lenora, KS 67645 |
Second Address | Norton, KS 67654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2011 |
Last Update Date | 03/11/2011 |