Individual
BARRY DWAYNE WHITESIDE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
126 MISSOURI AVE, MCXP-CCS-CR, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0417
(573) 596-0524
Mailing address
126 MISSOURI AVE, MCXP-CCS-CR, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0417
(573) 596-0524
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2789
SC
Other
Enumeration date
06/14/2006
Last updated
07/08/2007
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