Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2011017814 | MO |
NPI | 1013205962 |
---|---|
Provider Name | Ms. Bernadette Smith Flanery |
First Address | Hazelwood, MO 63042 |
Second Address | Hazelwood, MO 63042-1817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 13/07/2011 |