Individual
JACLYN PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2005 LIMESTONE AVE, COLUMBIA, MO 65203-8595
(573) 445-0510
Mailing address
2005 LIMESTONE AVE, COLUMBIA, MO 65203-8595
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2003027454
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003027454
PT LICENSE NUMBER
MO
Enumeration date
10/05/2007
Last updated
10/05/2007
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