Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2005029635 | MO |
NPI | 1013164995 |
---|---|
Provider Name | Sharon Rae Bruffett |
First Address | Cape Fair, MO 65624 |
Second Address | Kimberling City, MO 65686-9356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2008 |
Last Update Date | 22/08/2008 |