Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2001002813 | MO |
NPI | 1023155488 |
---|---|
Provider Name | Brenda Faye Foree |
First Address | Vandalia, MO 63382-3909 |
Second Address | Mexico, MO 65265-2821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |