Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2007022854 | MO |
NPI | 1003067729 |
---|---|
Provider Name | Miss Cynthia May Halbrook |
First Address | Weldon Spring, MO 63304-7585 |
Second Address | Weldon Spring, MO 63304-7585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 01/10/2008 |