Facts
- Status
- A
- Credential
- PTA
- Type
- Individual
- Enumeration date
- 2012-11-21
- Last updated
- 2012-11-21
Specialties
Licenses
- License TX
- 2074612
Location
- Practice location
- 110 E CENTER ST
- City
- MADISON SD
- Postal code
- 570422908
- Phone
- 785-643-5332
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.