Basic Information
| Provider Information | |||||||||
| NPI: | 1750896668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASKREN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 W LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | LINDSBORG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674562328 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 605 W LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | LINDSBORG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674562328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852273308 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2017 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 14-02298 | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 14-02298 | 05 | KS | MEDICAID |