Individual
KELSEY MIKALA LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1603 N CHAPEL HILL ST STE 400, WICHITA, KS 67206-5510
(316) 440-6551
Mailing address
550 W CENTRAL AVE APT 1707, WICHITA, KS 67203-4237
(316) 644-7816
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-02962
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14-02962
—
KS
Enumeration date
03/07/2016
Last updated
06/03/2016
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