Individual
MISTY GAYLE LUCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
714 SHERIDAN ST, FORT DODGE, KS 67843-9068
(620) 227-2121
Mailing address
201 CUSTER ST, FORT DODGE, KS 67843
(620) 227-2121
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-03536
KS
Other
Enumeration date
12/13/2019
Last updated
12/13/2019
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