Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 116274 | MO |
NPI | 1003076027 |
---|---|
Provider Name | William David Hosp |
First Address | Joplin, MO 64801-7638 |
Second Address | Granby, MO 64844-8336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 12/06/2008 |