Individual
RAEDENE FEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
14069 HIGHWAY 139, HALE, MO 64643-8231
(660) 565-2626
Mailing address
14069 HIGHWAY 139, HALE, MO 64643-8231
(660) 565-2626
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
117791
MO
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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