Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2013025653 | MO |
NPI | 1013312917 |
---|---|
Provider Name | Ashley Danielle Lewis |
First Address | Falcon, MO 65470-7180 |
Second Address | Falcon, MO 65470-7180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |