Individual
LISA THAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 N FOREST AVE, INDEPENDENCE, MO 64050-2696
(816) 521-5300
Mailing address
201 N FOREST AVE, INDEPENDENCE, MO 64050-2696
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2009020682
MO
Other
Enumeration date
08/23/2023
Last updated
08/23/2023
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