Individual
TASHA ALICE VORM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, LAT ATC
Contact information
Practice address
630 6TH ST, NEVADA, IA 50201
(515) 382-7008
(515) 382-7171
Mailing address
PO BOX 461, NEVADA, IA 50201-0461
(515) 382-3366
(515) 382-1576
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001444
IA
2255A2300X
Athletic Trainer
754YY8930
IA
Other
Enumeration date
04/26/2006
Last updated
08/13/2010
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