Individual
ALISA NOEL BLACKKETTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
201 S CEDAR ST, HILLSBORO, KS 67063-1311
(620) 877-0588
Mailing address
201 S CEDAR ST, HILLSBORO, KS 67063-1311
(620) 877-0588
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1088
ND
225200000X
Physical Therapy Assistant
Primary
14-02618
KS
Other
Enumeration date
12/22/2013
Last updated
12/22/2013
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