Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 00645 | MO |
NPI | 1255676516 |
---|---|
Provider Name | Mrs. Jane Dianne Huelskoetter |
First Address | Town And Country, MO 63017-8358 |
Second Address | Town And Country, MO 63017-5812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 27/11/2012 |