Individual
JODY COOLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8477 NORTH ST, BIRCH TREE, MO 65438-8887
(573) 292-3212
Mailing address
11 LONG AVE, ELLSINORE, MO 63937-8217
(573) 714-1033
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017012202
MISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS
MO
Enumeration date
02/15/2021
Last updated
02/16/2021
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