Individual
KATY BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3333 W 10TH ST, SEDALIA, MO 65301-2113
(660) 826-2118
Mailing address
3333 W 10TH ST, SEDALIA, MO 65301-2113
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2017036502
MO
Other
Enumeration date
12/07/2017
Last updated
12/07/2017
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