Individual
KELLY WUESTEWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4401 W BRIGGS DR, APT 68, SIOUX FALLS, SD 57107-6879
(605) 251-3730
Mailing address
4401 W BRIGGS DR, APT 68, SIOUX FALLS, SD 57107-6879
(605) 251-3730
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0376
SD
Other
Enumeration date
02/10/2014
Last updated
02/10/2014
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