Individual
KIM ILENE LOSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
604 RENNAKER ST, LA FONTAINE, IN 46940-9045
(765) 662-9350
Mailing address
4218 DARBY DR, FORT WAYNE, IN 46815-5265
(260) 486-8407
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004262A
IN
Other
Enumeration date
08/12/2011
Last updated
08/12/2011
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