Individual
TY BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 JEFFERSON ST, JEFFERSON CITY, MO 65101-2901
(573) 751-2194
Mailing address
6112 E FORSEE RD, ASHLAND, MO 65010-9296
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2018028389
MO
Other
Enumeration date
02/08/2019
Last updated
04/16/2026
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