Individual
MRS. MARY HELEN FISHBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1887 N HWY CC, NIXA, MO 65714-8015
(417) 725-5774
(417) 725-5915
Mailing address
720 S LIPSCOMB, REPUBLIC, MO 65738-2282
(417) 732-9589
(417) 732-9589
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2001003375
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922129725
22 MASSAGE THERAPIST
MO
Enumeration date
04/02/2007
Last updated
11/15/2007
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