Individual
KYLEE NUSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1948 MESQUITE AVE, SUITE 101, LAKE HAVASU CITY, AZ 86403-5777
(928) 854-4776
Mailing address
1948 MESQUITE AVE, SUITE 101, LAKE HAVASU CITY, AZ 86403-5777
(928) 854-4776
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9592
AZ
Other
Enumeration date
11/22/2011
Last updated
11/22/2011
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