Healthcare Provider Details

I. General information

NPI: 1053229104
Provider Name (Legal Business Name): TAEGEN ANN PEDIGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S BUHLER RD
BUHLER KS
67522-8133
US

IV. Provider business mailing address

108 HALL ST
SPEARVILLE KS
67876-8540
US

V. Phone/Fax

Practice location:
  • Phone: 620-546-2251
  • Fax:
Mailing address:
  • Phone: 620-385-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberT-06603
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: