Individual
MRS. SHAWN LARAE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4500 E 32ND ST, JOPLIN, MO 64804
(417) 623-6287
(417) 623-3504
Mailing address
4500 E 32ND ST, JOPLIN, MO 64804
(417) 623-6287
(417) 623-3504
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116146
MO
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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