Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 2014019530 | MO |
Y | 2251P0200X | Physical Therapist - Pediatrics | 2014019530 | MO |
NPI | 1134528656 |
---|---|
Provider Name | Cassie Stephans |
First Address | Bolivar, MO 65613-3011 |
Second Address | Bolivar, MO 65613-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 20/08/2014 |