Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 02049 | MO |
NPI | 1013181189 |
---|---|
Provider Name | Mrs. Sarah Ann Jones |
First Address | Bolivar, MO 65613-2897 |
Second Address | Bolivar, MO 65613-2897 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 18/04/2008 |