Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2019039394 | MO |
NPI | 1003446584 |
---|---|
Provider Name | Mr. Brendan Scott Owsley |
First Address | Camdenton, MO 65020-2659 |
Second Address | Camdenton, MO 65020-2659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 23/01/2020 |