Healthcare Provider Details

I. General information

NPI: 1548046485
Provider Name (Legal Business Name): TONYA VERSTEEG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DYNAMIC BODY 1344 E WOODHURST DR
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

1932 E LAKEWOOD ST
SPRINGFIELD MO
65804-7555
US

V. Phone/Fax

Practice location:
  • Phone: 417-844-4652
  • Fax:
Mailing address:
  • Phone: 417-844-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2017001859
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: