Individual
KATELYN MARIE MIKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4102 VESTAL RD, VESTAL, NY 13850-3553
(607) 772-1598
Mailing address
403 DWIGHT AVE, ENDICOTT, NY 13760-4045
(607) 768-5283
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
006946-1
NY
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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