MEDICARE: RYAN PEZLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2007028410	MO

General Provider Information

NPI Number	:	1174854368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN PEZLEY

Provider Business Mailing Address
First Line	:	1701 LAWRENCE PL
Second Line	:
City	:	MEXICO
State	:	MO
Zip	:	65265-3422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 LAWRENCE PL
Second Line	:
City	:	MEXICO
State	:	MO
Zip	:	65265-3422
Country	:	US
Telephone Number	:	573-581-4452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	01/27/2010

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Directions to “ RYAN PEZLEY ” Practice Location

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