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NPI Code Detail

MEDICARE: MARRIETA A HUTTENLOCHER PT

MEDICARE: MARRIETA A HUTTENLOCHER PT
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
1225100000XPhysical Therapist112002MO

General Provider Information

NPI Number : 1285734806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARRIETA A HUTTENLOCHER PT
Provider Business Mailing Address
First Line : 3603 W SEXTON ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65810-1023
Country : US
Telephone Number : 417-882-2333
Fax Number :
Provider Business Practice Location Address
First Line : 2800 S FORT AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-3480
Country : US
Telephone Number : 417-882-0035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2006
Last Update Date : 07/08/2007

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