Healthcare Provider Details

I. General information

NPI: 1144436056
Provider Name (Legal Business Name): PATRECIA P STAMPER P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 OAK FOREST DR A
ROLLA MO
65401-9378
US

IV. Provider business mailing address

PO BOX 2209
ROLLA MO
65402-2209
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-4443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number117343
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-00155
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: