Individual
KATHLEEN L SLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1090 S HIGHWAY 89, JACKSON, WY 83001
(307) 733-5577
(307) 733-5505
Mailing address
PO BOX 8467, JACKSON, WY 83002-8467
(307) 733-5577
(307) 733-5505
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-465
WY
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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