Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 109294 | MO |
NPI | 1043848427 |
---|---|
Provider Name | Mrs. Jennifer Suzanne Ward |
First Address | Ozark, MO 65721-6009 |
Second Address | Springfield, MO 65807-7310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2020 |
Last Update Date | 31/03/2020 |