Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2002022527 | MO |
NPI | 1003023664 |
---|---|
Provider Name | Amy Patricia Dunckel |
First Address | Lebanon, MO 65536-4351 |
Second Address | Lebanon, MO 65536-9217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |