Individual
MRS. JENNIFER MARIE PROBSTFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2900 S NATIONAL AVE, SPRINGFIELD, MO 65804-3634
(417) 885-3888
Mailing address
5311 S PARKHILL AVE, SPRINGFIELD, MO 65810-2575
(417) 496-0559
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2005024707
MO
225700000X
Massage Therapist
2004031355
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA3058
PTAN
MO
Enumeration date
08/25/2005
Last updated
10/24/2011
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