Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 116884 | MO |
NPI | 1003957002 |
---|---|
Provider Name | Lori Hall |
First Address | West Plains, MO 65775-1100 |
Second Address | West Plains, MO 65775-2029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2007 |
Last Update Date | 08/07/2007 |