Healthcare Provider Details

I. General information

NPI: 1164694576
Provider Name (Legal Business Name): MRS. KAREN JOY ABANDO CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18540 STATE HIGHWAY 16
LEWISTOWN MO
63452-2111
US

IV. Provider business mailing address

214 W 5TH ST STE D&E
JOPLIN MO
64801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 573-215-2216
  • Fax:
Mailing address:
  • Phone: 417-782-2917
  • Fax: 417-782-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006002905
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: