MEDICARE: MRS. DOROTHY PAULETTE TOOLEY PTA

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	115573	MO

General Provider Information

NPI Number	:	1750583654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY PAULETTE TOOLEY PTA

Provider Business Mailing Address
First Line	:	964 STATE ROUTE 76
Second Line	:	P.O. BOX 637
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793-8219
Country	:	US
Telephone Number	:	417-469-5621
Fax Number	:	417-469-3042

Provider Business Practice Location Address
First Line	:	2646 STATE ROUTE 76
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793-8254
Country	:	US
Telephone Number	:	417-469-3152
Fax Number	:	417-469-3042

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

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	07/08/2007

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