Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 11-02962 | KS |
NPI | 1134564024 |
---|---|
Provider Name | Valerie Christine Wondra |
First Address | Wichita, KS 67230-7576 |
Second Address | Wichita, KS 67226-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 01/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201142720A | (05) | KS |