Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 115308 | MO |
NPI | 1013288521 |
---|---|
Provider Name | Theresa Carol Barlow |
First Address | Kansas City, MO 64118-1558 |
Second Address | Liberty, MO 64068-1036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2012 |
Last Update Date | 16/01/2012 |