Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2014027174 | MO |
NPI | 1003225962 |
---|---|
Provider Name | Tasha Stuckenschneider |
First Address | Osage Beach, MO 65065-3188 |
Second Address | Osage Beach, MO 65065-3188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2014 |
Last Update Date | 05/08/2014 |