Individual
KALI BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
601 HIGHWAY 61 S, WAPELLO, IA 52653-1364
(319) 470-4380
Mailing address
1220 AVENUE B, FORT MADISON, IA 52627-2729
(319) 470-4380
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
073030
IA
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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