Individual
MRS. HEIDI LYNN ELLWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
20270 HARLEQUIN LN, DIXON, MO 65459-7524
(573) 336-4965
Mailing address
20270 HARLEQUIN LN, DIXON, MO 65459-7524
(573) 336-4965
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2005019387
MO
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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