Individual
SU COLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPTA
Contact information
Practice address
104 W MARKET ST, SUITE B, OSAGE CITY, KS 66523-1277
(785) 528-1123
(785) 528-4123
Mailing address
104 W MARKET ST, SUITE B, OSAGE CITY, KS 66523-1277
(785) 528-1123
(785) 528-4123
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-01837
KS
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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