Individual
KATHRYN ULLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2611 SOLERA MOON DR, HENDERSON, NV 89044-4440
(304) 520-1538
Mailing address
2611 SOLERA MOON DR, HENDERSON, NV 89044-4440
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
011711-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011711-1
—
NY
Enumeration date
10/22/2018
Last updated
10/22/2018
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