Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 00649 | MO |
NPI | 1003028234 |
---|---|
Provider Name | Ms. Marie Shireman |
First Address | Joplin, MO 64801-3631 |
Second Address | Joplin, MO 64804-1626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |