Individual
GARY LEROY HACKNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
310 ROUTE 66 E, WAYNESVILLE, MO 65583-2648
(573) 855-1213
Mailing address
310 ROUTE 66 E, WAYNESVILLE, MO 65583-2648
(573) 855-1213
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2012024227
MO
Other
Enumeration date
05/19/2020
Last updated
05/19/2020
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