Individual
THAD MICHAEL DEWEESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC-L
Contact information
Practice address
1801 N KANSAS AVE, LIBERAL, KS 67901-2054
(620) 629-2671
(620) 626-3005
Mailing address
1331 S SHERMAN AVE, LIBERAL, KS 67901-4710
(620) 624-6695
(620) 626-3005
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-00040
KS
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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