Individual
HAVEN MINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
(573) 348-8000
Mailing address
271 SNELLINGS LN, MONTREAL, MO 65591-7564
(573) 692-0960
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
02/01/2022
Last updated
02/01/2022
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