Individual
JERIMY OBERGOENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3047 WILLIAM ST, SUITE 100, CAPE GIRARDEAU, MO 63703-6393
(573) 339-5989
Mailing address
2825 OLD TOLL RD, JACKSON, MO 63755-3023
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2014002160
MO
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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