Raumie J Wilson, PTA
Individual provider Active NPI Physical Therapy Assistant · Eudora, KS
NPI 1063662666 · NPPES record last updated Sep 19, 2008
Key facts
- NPI
- 1063662666
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 1401283 (KS)
- Practice address
- 1415 Maple St
Eudora, KS 66025-9419 - Phone
- (615) 896-6400
- NPI assigned
- Sep 19, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1401283 | KS | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1401283 | KS | Yes |
Addresses
Primary practice location
1415 Maple St
Eudora, KS 66025-9419
Mailing address
705 Sturbridge CT
Lawrence, KS 66049-3671
Phone (615) 896-6400
Other providers in Eudora, KS
All providers in Eudora, KS · Physical Therapy Assistant in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.