Individual
ANTONIO DE JESUS CARRASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1818 BAKER AVE, GREAT BEND, KS 67530-2726
(620) 617-3259
Mailing address
1818 BAKER AVE, GREAT BEND, KS 67530-2726
(620) 617-3259
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-03867
KS
Other
Enumeration date
10/04/2021
Last updated
10/04/2021
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