Individual
ALIECIA DIANN PENROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1420 WOODLAND DR, JACKSON, MO 63755-1510
(573) 587-4204
Mailing address
1420 WOODLAND DR, JACKSON, MO 63755-1510
(573) 587-4204
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2016037455
MO
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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