Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2000155882 | MO |
NPI | 1407864564 |
---|---|
Provider Name | Prof. Ann Marie Decker |
First Address | Kansas City, MO 64114-1238 |
Second Address | Kansas City, MO 64111-2658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |