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General NPI Number Information
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NPI Number | 1871158303
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Entity Type | Individual
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Provider Name | DUSTIN CAINE
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Gender | Male
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 2900 N CAMPUS DR
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City | GARDEN CITY
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State | KS
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Zip | 67846-3997
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Country | US
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Telephone | 620-640-3146
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 E MELANIE LN
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City | GARDEN CITY
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State | KS
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Zip | 67846-4755
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-03342
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License Number State | KS
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