Individual
MCKINZIE GALE EDSTENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8905 EVERGREEN AVE, INDIANAPOLIS, IN 46240-2000
(317) 571-1250
Mailing address
119 STONEGATE DR, NEW CASTLE, IN 47362-1791
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005891A
IN
Other
Enumeration date
07/15/2020
Last updated
07/15/2020
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