Individual
DAPHNE WIEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1030 EDMONDS ST, JEFFERSON CITY, MO 65109-5213
(615) 896-6400
Mailing address
185 GOTT PLANTATION RD, ULMAN, MO 65083-2018
(573) 280-4586
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2004015187
MO
Other
Enumeration date
06/06/2007
Last updated
07/08/2007
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