Individual
BRANDY DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
419 HARDING ST, CLAYTON, NM 88415-3323
(575) 374-2562
Mailing address
719 E LOVE ST, MEXICO, MO 65265-2912
(573) 258-9050
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2015036824
MO
225200000X
Physical Therapy Assistant
A-1210
NM
Other
Enumeration date
03/04/2016
Last updated
03/04/2016
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