Individual
MISS STACEY JO CHUDOMELKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1100 W 2ND ST, OSHKOSH, NE 69154-6152
(308) 772-3283
Mailing address
PO BOX 373, OSHKOSH, NE 69154-0373
(402) 598-4259
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1209
NE
Other
Enumeration date
08/12/2013
Last updated
08/12/2013
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