Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2020024366 | MO |
NPI | 1033879564 |
---|---|
Provider Name | Morgan Scardino |
First Address | Republic, MO 65738-7574 |
Second Address | Republic, MO 65738-7574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2021 |
Last Update Date | 24/12/2021 |