Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2005028334 | MO |
NPI | 1003030990 |
---|---|
Provider Name | Dixie Leah Mattthews |
First Address | Saint Joseph, MO 64503-1159 |
Second Address | Saint Joseph, MO 64503-1159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |